Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6015 | AL |
NPI | 1003255720 |
---|---|
Provider Name | Dr. Preston Callaway Adams |
First Address | Mountain Brk, AL 35213-4435 |
Second Address | Homewood, AL 35209-6809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2013 |
Last Update Date | 09/06/2021 |