Provider Demographics
NPI:1639419369
Name:SEMANOFF, ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:SEMANOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 LENA RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9500
Mailing Address - Country:US
Mailing Address - Phone:215-630-3454
Mailing Address - Fax:
Practice Address - Street 1:5460 LENA RD UNIT 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211
Practice Address - Country:US
Practice Address - Phone:215-630-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN231821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery