Provider Demographics
NPI:1104246750
Name:ADAMS, KENNETH JR (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ADAMS
Suffix:JR
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 1:1759 VIDALIA CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6946
Mailing Address - Country:US
Mailing Address - Phone:317-691-8838
Mailing Address - Fax:
Practice Address - Street 1:1759 VIDALIA CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6946
Practice Address - Country:US
Practice Address - Phone:317-691-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007211A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice