Patricia Adesanya, D.D.S.
Individual provider Active NPI Dentist · Bastrop, TX
NPI 1245646181 · NPPES record last updated Jul 26, 2014
Key facts
- NPI
- 1245646181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 29971 (TX)
- Practice address
- 275 S Jackson St
Bastrop, TX 78602-4313 - Phone
- (512) 321-7137
- NPI assigned
- Jul 10, 2014
- 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)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 29971 | TX | Yes |
Addresses
Primary practice location
275 S Jackson St
Bastrop, TX 78602-4313
Mailing address
275 S Jackson St
Bastrop, TX 78602-4313
Phone (512) 321-7137
Other providers in Bastrop, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2014. 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.