Provider Demographics
NPI:1679727929
Name:ADAM, EMILIA C (PEDIATRIC DENTIST)
Entity type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:C
Last Name:ADAM
Suffix:
Gender:F
Credentials:PEDIATRIC DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:13831 NW CORNELL RD
Mailing Address - Street 2:C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5485
Mailing Address - Country:US
Mailing Address - Phone:503-718-3762
Mailing Address - Fax:503-718-3766
Practice Address - Street 1:13831 NW CORNELL RD
Practice Address - Street 2:C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5485
Practice Address - Country:US
Practice Address - Phone:503-718-3762
Practice Address - Fax:503-718-3766
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry