Provider Demographics
NPI:1063767499
Name:ERDMANN, ADAM DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:ERDMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 HOLTON DR
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3759
Mailing Address - Country:US
Mailing Address - Phone:712-546-4556
Mailing Address - Fax:712-546-4568
Practice Address - Street 1:827 HOLTON DR
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3759
Practice Address - Country:US
Practice Address - Phone:712-546-4556
Practice Address - Fax:712-546-4568
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist