Provider Demographics
NPI:1982824173
Name:ADAM, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577
Mailing Address - Country:US
Mailing Address - Phone:641-673-4432
Mailing Address - Fax:
Practice Address - Street 1:2335 HWY 92 E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577
Practice Address - Country:US
Practice Address - Phone:641-673-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist