Provider Demographics
NPI:1861557837
Name:ADAMS, BRYAN (DMD MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # D7-6
Mailing Address - Street 2:PO BOX 100416
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-273-6750
Mailing Address - Fax:352-392-7609
Practice Address - Street 1:1600 SW ARCHER RD # D7-6
Practice Address - Street 2:BOX 100416
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-6750
Practice Address - Fax:352-392-7609
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-0097-061223G0001X
FLDRP5511223S0112X
FLTRN#15897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery