Provider Demographics
NPI:1710900501
Name:ADAMS, KATHLEEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24421-2315
Mailing Address - Country:US
Mailing Address - Phone:540-885-8670
Mailing Address - Fax:
Practice Address - Street 1:850 STATLER BLVD
Practice Address - Street 2:STE 110
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4885
Practice Address - Country:US
Practice Address - Phone:540-887-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA107068OtherANTHEM PROVIDER NUMBER