1386747988 NPI number — CHARLES ADAMO PERIODONTICS PA

Table of content: (NPI 1386747988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386747988 NPI number — CHARLES ADAMO PERIODONTICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES ADAMO PERIODONTICS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MILLCREEK PERIODONTICS & DENTAL IMPLANTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386747988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWITT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76643-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-754-1456
Provider Business Mailing Address Fax Number:
254-754-0907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8418 OLD MCGREGOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-754-1456
Provider Business Practice Location Address Fax Number:
254-754-0907
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMO
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
254-754-1456

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1158857 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com