Provider Demographics
NPI:1427439405
Name:PROCTOR, ADAM (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 E GATEWAY DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4616
Mailing Address - Country:US
Mailing Address - Phone:435-657-1700
Mailing Address - Fax:
Practice Address - Street 1:376 E GATEWAY DR STE 202
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4616
Practice Address - Country:US
Practice Address - Phone:435-657-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0092711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice