Provider Demographics
NPI:1811001092
Name:ADAMS, MATTHEW REID (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:REID
Last Name:ADAMS
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 1:5605 PRINCETON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9069
Mailing Address - Country:US
Mailing Address - Phone:706-323-8811
Mailing Address - Fax:706-323-8824
Practice Address - Street 1:5605 PRINCETON AVE
Practice Address - Street 2:STE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9069
Practice Address - Country:US
Practice Address - Phone:706-323-8811
Practice Address - Fax:706-323-8824
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN12383122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice