Provider Demographics
NPI:1841412798
Name:ADAM, SOPHIE REJEANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:REJEANNE
Last Name:ADAM
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 1:13733 N PRASADA PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-8014
Mailing Address - Country:US
Mailing Address - Phone:623-302-0288
Mailing Address - Fax:
Practice Address - Street 1:13733 N PRASADA PKWY STE 108
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-8014
Practice Address - Country:US
Practice Address - Phone:623-777-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist