Provider Demographics
NPI:1952071615
Name:HESS, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E FORT UNION BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5645
Mailing Address - Country:US
Mailing Address - Phone:801-561-9999
Mailing Address - Fax:
Practice Address - Street 1:204 E FORT UNION BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5645
Practice Address - Country:US
Practice Address - Phone:801-561-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7912793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist