John E. Adcock, D.D.S., M.S.
Individual provider Active NPI Periodontics · Tyler, TX
NPI 1922005503 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1922005503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 10911 (TX)
- Practice address
- 3805 Brookside Dr
Tyler, TX 75701-9421 - Phone
- (903) 288-8805
- Fax
- (903) 509-0160
- NPI assigned
- Jun 28, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- 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 |
|---|---|---|---|---|
| I20150903002652 | TX | Order and Referring Only - Oral Surgery |
2860708955 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10911 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tyler Periodontics, PLLC | Periodontics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 10911 | TX | Yes |
Addresses
Primary practice location
3805 Brookside Dr
Tyler, TX 75701-9421
Mailing address
3805 Brookside Dr
Tyler, TX 75701-9421
Phone (903) 288-8805
Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.