Provider Demographics
NPI:1104877380
Name:JANETTE, ADAM JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:JANETTE
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 1:77 CASA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5803
Mailing Address - Country:US
Mailing Address - Phone:805-541-5611
Mailing Address - Fax:805-541-2328
Practice Address - Street 1:77 CASA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5803
Practice Address - Country:US
Practice Address - Phone:805-541-5611
Practice Address - Fax:805-541-2328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery