Provider Demographics
NPI:1982770715
Name:ADAMS, RODERICK HENRY JR (DDS)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:HENRY
Last Name:ADAMS
Suffix:JR
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 1:1464 E 105TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1100
Mailing Address - Country:US
Mailing Address - Phone:216-421-6000
Mailing Address - Fax:216-421-1627
Practice Address - Street 1:1464 E 105TH ST
Practice Address - Street 2:STE 203
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1100
Practice Address - Country:US
Practice Address - Phone:216-421-6000
Practice Address - Fax:216-421-1627
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558383Medicaid