Provider Demographics
NPI:1992929293
Name:KADOLPH, ADAM JARRETT (DMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JARRETT
Last Name:KADOLPH
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 1:217 ROCK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5543
Mailing Address - Country:US
Mailing Address - Phone:757-234-6234
Mailing Address - Fax:
Practice Address - Street 1:7151 RICHMOND ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-565-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice