Provider Demographics
NPI:1922005503
Name:ADCOCK, JOHN E (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9421
Mailing Address - Country:US
Mailing Address - Phone:903-288-8805
Mailing Address - Fax:903-509-0160
Practice Address - Street 1:3805 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9421
Practice Address - Country:US
Practice Address - Phone:903-288-8805
Practice Address - Fax:903-509-0160
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics