Provider Demographics
NPI:1811373764
Name:ADAMS, SUSAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CONWYCK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2630
Mailing Address - Country:US
Mailing Address - Phone:314-482-6270
Mailing Address - Fax:
Practice Address - Street 1:1321 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2329
Practice Address - Country:US
Practice Address - Phone:636-931-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO015628OtherMISSOURI DENTAL BOARD