Provider Demographics
NPI:1285314856
Name:ADAMS, ANNALEE
Entity type:Individual
Prefix:
First Name:ANNALEE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1306
Mailing Address - Country:US
Mailing Address - Phone:606-269-8404
Mailing Address - Fax:
Practice Address - Street 1:85 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8801
Practice Address - Country:US
Practice Address - Phone:606-596-0410
Practice Address - Fax:606-598-1117
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist