Provider Demographics
NPI:1023172830
Name:ADAMS, SCOTT ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ERNEST
Last Name:ADAMS
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 1:1710 E MARCH LN
Mailing Address - Street 2:STE 2B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5665
Mailing Address - Country:US
Mailing Address - Phone:209-474-1000
Mailing Address - Fax:209-474-8429
Practice Address - Street 1:1710 E MARCH LN
Practice Address - Street 2:STE 2B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5665
Practice Address - Country:US
Practice Address - Phone:209-474-1000
Practice Address - Fax:209-474-8429
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 301761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3017601OtherDENTICAL