Provider Demographics
NPI:1023127867
Name:ADAMS, PHIL (DMD)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:
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 1:260 WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042
Mailing Address - Country:US
Mailing Address - Phone:205-926-4697
Mailing Address - Fax:205-926-4684
Practice Address - Street 1:260 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042
Practice Address - Country:US
Practice Address - Phone:205-926-4697
Practice Address - Fax:205-926-4684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL020141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist