Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2008003837 | MO |
NPI | 1003086737 |
---|---|
Provider Name | Mark F Adams |
First Address | Arnold, MO 63010-2006 |
Second Address | Arnold, MO 63010-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 04/05/2010 |