Provider Demographics
NPI:1952430142
Name:ADAMS, MICHAEL GARY (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARY
Last Name:ADAMS
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 1:307 GRETNA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053
Mailing Address - Country:US
Mailing Address - Phone:504-361-5367
Mailing Address - Fax:504-368-4846
Practice Address - Street 1:307 GRETNA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053
Practice Address - Country:US
Practice Address - Phone:504-361-5367
Practice Address - Fax:504-368-4846
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice