Provider Demographics
NPI:1851085682
Name:ADAMS, RYAN SAMUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SAMUEL
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 1:1336 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-3314
Mailing Address - Country:US
Mailing Address - Phone:509-758-5011
Mailing Address - Fax:
Practice Address - Street 1:1336 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-3314
Practice Address - Country:US
Practice Address - Phone:509-758-5011
Practice Address - Fax:509-751-9125
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614120651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice