Provider Demographics
NPI:1649427964
Name:TA, ADAM H (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:H
Last Name:TA
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 1:2410 EVERGREEN ROAD, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-721-3393
Mailing Address - Fax:410-721-4837
Practice Address - Street 1:2923 OLNEY SANDY SPRING RD STE D
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1583
Practice Address - Country:US
Practice Address - Phone:301-924-5500
Practice Address - Fax:301-924-0412
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry