Wid Adams, DDS
Individual provider Active NPI Dentist · Chicago, IL
NPI 1013672609 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1013672609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.033633 (IL)
- Practice address
- 6560 W Fullerton Ave Unit C106
Chicago, IL 60707-3439 - Phone
- (773) 385-6700
- NPI assigned
- Nov 8, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033633 | IL | MD | Dentist |
Networks
- IL HMO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 019.033633 | IL | Yes |
Addresses
Primary practice location
6560 W Fullerton Ave Unit C106
Chicago, IL 60707-3439
Mailing address
6560 W Fullerton Ave Unit C106
Chicago, IL 60707-3439
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.