Provider Demographics
NPI:1962847608
Name:CUMMINS, ADRIAN JAMAAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:JAMAAL
Last Name:CUMMINS
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 1:2020 WALNUT ST
Mailing Address - Street 2:APT 17J
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5635
Mailing Address - Country:US
Mailing Address - Phone:443-453-6987
Mailing Address - Fax:
Practice Address - Street 1:111 S INDEPENDENCE MALL E
Practice Address - Street 2:SUITE 610
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2515
Practice Address - Country:US
Practice Address - Phone:215-238-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040442122300000X
NY057488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist