Provider Demographics
NPI:1063582252
Name:ADAMS, KATHLEENE G (DMD)
Entity type:Individual
Prefix:
First Name:KATHLEENE
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHLEENE
Other - Middle Name:G
Other - Last Name:ADAMS BELUSKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:419 NW 23RD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-224-2273
Mailing Address - Fax:503-224-1176
Practice Address - Street 1:419 NW 23RD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-224-2273
Practice Address - Fax:503-224-1176
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist