Provider Demographics
NPI:1588748529
Name:ADAMSON, NEIL D (DDS)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:D
Last Name:ADAMSON
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 1:270 E 5TH N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2749
Mailing Address - Country:US
Mailing Address - Phone:208-587-9031
Mailing Address - Fax:208-587-9031
Practice Address - Street 1:270 E 5TH N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2749
Practice Address - Country:US
Practice Address - Phone:208-587-9031
Practice Address - Fax:208-587-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-16201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice