Provider Demographics
NPI:1699933291
Name:ADAMS&GIMLEN DENTAL PARTNERSHIP
Entity type:Organization
Organization Name:ADAMS&GIMLEN DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-545-6525
Mailing Address - Street 1:973 MANHATTAN BEACH BLVD
Mailing Address - Street 2:#C
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5131
Mailing Address - Country:US
Mailing Address - Phone:310-545-6525
Mailing Address - Fax:310-546-6203
Practice Address - Street 1:973 MANHATTAN BEACH BLVD
Practice Address - Street 2:#C
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5131
Practice Address - Country:US
Practice Address - Phone:310-545-6525
Practice Address - Fax:310-546-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252281223X0400X
CA530651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty