Provider Demographics
NPI:1952439010
Name:ADAIR, GARRY RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:RUSSELL
Last Name:ADAIR
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 1:1700 HORIZON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3950
Mailing Address - Country:US
Mailing Address - Phone:215-997-0740
Mailing Address - Fax:215-997-0743
Practice Address - Street 1:1700 HORIZON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3950
Practice Address - Country:US
Practice Address - Phone:215-997-0740
Practice Address - Fax:215-997-0743
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019297L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice