Active NPI
Adam K Goodwin, D.M.D.
- Pediatric Dentistry
- Bastrop, TX
National Provider Identifier
1710278478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 28771
- Practice address
- 696 Highway 71 W Ste 4D
Bastrop, TX 78602-5151 - Phone
- (512) 321-5437
- Fax
- (888) 317-1936
- NPI assigned
- Apr 28, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 28771 | TX | Primary |
Addresses
Primary practice location
696 Highway 71 W Ste 4D
Bastrop, TX 78602-5151
Mailing address
696 Highway 71 W Ste 4D
Bastrop, TX 78602-5151
Phone (512) 321-5437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28771 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507593600000",
"number": "1710278478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "696 HIGHWAY 71 W STE 4D",
"city": "BASTROP",
"state": "TX",
"postal_code": "786025151",
"telephone_number": "512-321-5437",
"fax_number": "888-317-1936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "696 HIGHWAY 71 W STE 4D",
"city": "BASTROP",
"state": "TX",
"postal_code": "786025151",
"telephone_number": "512-321-5437",
"fax_number": "888-317-1936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWIN",
"first_name": "ADAM",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-28",
"last_updated": "2017-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "28771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bastrop, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.