Provider Demographics
NPI:1386747988
Name:CHARLES ADAMO PERIODONTICS PA
Entity type:Organization
Organization Name:CHARLES ADAMO PERIODONTICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ADAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:254-754-1456
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-1429
Mailing Address - Country:US
Mailing Address - Phone:254-754-1456
Mailing Address - Fax:254-754-0907
Practice Address - Street 1:8418 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-754-1456
Practice Address - Fax:254-754-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty