Provider Demographics
NPI:1013167113
Name:ADAM R. PERSHING
Entity Type:Organization
Organization Name:ADAM R. PERSHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/SOLE MEMBER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PERSHING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-722-2992
Mailing Address - Street 1:2300 N CRAYCROFT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2808
Mailing Address - Country:US
Mailing Address - Phone:520-722-2992
Mailing Address - Fax:520-722-2993
Practice Address - Street 1:2300 N CRAYCROFT RD STE 4
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2808
Practice Address - Country:US
Practice Address - Phone:520-722-2992
Practice Address - Fax:520-722-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFP0272120OtherDEA REGISTRATION NUMBER