Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 54019 | MN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 7961990-1205 | UT |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7961990-9924 | UT |
N | 204E00000X | Oral & Maxillofacial Surgeon | D12304 | MN |
NPI | 1174604128 |
---|---|
Provider Name | Nathan G Adams |
First Address | Salt Lake City, UT 84124-1266 |
Second Address | Salt Lake City, UT 84124-1266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V10476 | (02) |