Provider Demographics
NPI:1104881655
Name:ADAMS, GREG STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:STANLEY
Last Name:ADAMS
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 1:1083 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4240
Mailing Address - Country:US
Mailing Address - Phone:360-659-0864
Mailing Address - Fax:360-651-1780
Practice Address - Street 1:1083 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4240
Practice Address - Country:US
Practice Address - Phone:360-659-0864
Practice Address - Fax:360-651-1780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice