Provider Demographics
NPI:1629156864
Name:ADAMS, PATTY V (DMD PSC)
Entity Type:Individual
Prefix:DR
First Name:PATTY
Middle Name:V
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 SOUTH HURSTBOURNE PKWY
Mailing Address - Street 2:STE 7
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220
Mailing Address - Country:US
Mailing Address - Phone:502-493-8218
Mailing Address - Fax:
Practice Address - Street 1:2821 SOUTH HURSTBOURNE PKWY
Practice Address - Street 2:STE 7
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220
Practice Address - Country:US
Practice Address - Phone:502-493-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY057711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice