Provider Demographics
NPI:1831282755
Name:ADAMS, DAVID RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E HERNDON AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3100
Mailing Address - Country:US
Mailing Address - Phone:559-431-4220
Mailing Address - Fax:559-431-9276
Practice Address - Street 1:1111 E HERNDON AVE STE 119
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3100
Practice Address - Country:US
Practice Address - Phone:559-431-4220
Practice Address - Fax:559-431-9276
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24220ZMedicare ID - Type Unspecified
CAT08572Medicare UPIN