Provider Demographics
NPI:1982770715
Name:ADAMS, RODERICK HENRY JR (DDS)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:HENRY
Last Name:ADAMS
Suffix:JR
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 1:13922 CEDAR RD # 3
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3204
Mailing Address - Country:US
Mailing Address - Phone:216-721-0500
Mailing Address - Fax:216-721-5775
Practice Address - Street 1:13922 CEDAR RD # 3
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3204
Practice Address - Country:US
Practice Address - Phone:216-721-0500
Practice Address - Fax:216-721-5775
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0156341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558383Medicaid