Individual
JILL A ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4379 RIDGEWOOD CENTER DR, STE 102, WOODBRIDGE, VA 22192-8323
(703) 680-7950
(703) 680-7953
Mailing address
1414 SHINING ARMOR LN, WEST LAFAYETTE, IN 47906-5473
(765) 412-6582
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12010250A
IN
122300000X
Dentist
Primary
401412281
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12010250A
STATE LICENSE
ID
05
—
200327070
—
ID
Enumeration date
09/26/2006
Last updated
05/29/2012
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