Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | DEN-9878 | CO |
Y | 1223E0200X | Endodontist | DEN.00009878 | CO |
N | 1223E0200X | Endodontist | DN 16025 | FL |
NPI | 1073561213 |
---|---|
Provider Name | Dr. Adam John Mckissock |
First Address | Colorado Springs, CO 80920-7901 |
Second Address | Colorado Springs, CO 80920-7901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 12/07/2016 |