Jill A Adams, DDS
Individual provider Active NPI Dentist · Woodbridge, VA
NPI 1386745644 · NPPES record last updated May 29, 2012
Key facts
- NPI
- 1386745644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 401412281 (VA)
- Practice address
- 4379 Ridgewood Center Dr
Ste 102
Woodbridge, VA 22192-8323 - Phone
- (703) 680-7950
- Fax
- (703) 680-7953
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150514000316 | IN | Order and Referring Only - Dentist |
9638208804 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 401412281 | VA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12010250A | IN | |
| Dentist | 122300000X | 401412281 | VA | Yes |
Addresses
Primary practice location
4379 Ridgewood Center Dr
Ste 102
Woodbridge, VA 22192-8323
Mailing address
1414 Shining Armor LN
West Lafayette, IN 47906-5473
Phone (765) 412-6582
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12010250A | Other | ID | STATE LICENSE |
| 200327070 | Medicaid | ID |
Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.