Provider Demographics
NPI:1336440676
Name:R. CLYNE ADAMS, D.M.D.
Entity Type:Organization
Organization Name:R. CLYNE ADAMS, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:CLYNE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-734-1810
Mailing Address - Street 1:509 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-4043
Mailing Address - Country:US
Mailing Address - Phone:256-734-1810
Mailing Address - Fax:256-734-1843
Practice Address - Street 1:509 5TH ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4043
Practice Address - Country:US
Practice Address - Phone:256-734-1810
Practice Address - Fax:256-734-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty