Provider Demographics
NPI:1134435654
Name:ADAMS DENTAL HEALTH, LLC
Entity type:Organization
Organization Name:ADAMS DENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KOKAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-779-7645
Mailing Address - Street 1:518 MYOMA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2324
Mailing Address - Country:US
Mailing Address - Phone:724-779-7645
Mailing Address - Fax:
Practice Address - Street 1:518 MYOMA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2324
Practice Address - Country:US
Practice Address - Phone:724-779-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022717-L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101533679 0001Medicaid