Provider Demographics
NPI:1992761126
Name:ADAM C PLASTER DDS PC
Entity type:Organization
Organization Name:ADAM C PLASTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PLASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-322-4006
Mailing Address - Street 1:134 SOUTH COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605
Mailing Address - Country:US
Mailing Address - Phone:276-322-4006
Mailing Address - Fax:276-322-0302
Practice Address - Street 1:134 SOUTH COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-4006
Practice Address - Fax:276-322-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410196261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178673Medicaid