James Farris Adjan, DDS
Individual provider Active NPI Pediatric Dentistry · Bastrop, TX
NPI 1962527481 · NPPES record last updated Nov 4, 2011
Key facts
- NPI
- 1962527481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 25351 (TX)
- Practice address
- 696 Highway 71 W
Suite 4D
Bastrop, TX 78602-4009 - Phone
- (512) 321-5437
- Fax
- (888) 317-1936
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- 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 |
|---|---|---|---|
| 30022364 | OH | MD | General Practice Dentistry |
| 25351 | TX | MD | Pediatric Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30022364 | OH | |
| Pediatric Dentistry | 1223P0221X | 25351 | TX | Yes |
Addresses
Primary practice location
696 Highway 71 W
Suite 4D
Bastrop, TX 78602-4009
Mailing address
696 Highway 71 W
Suite 4D
Bastrop, TX 78602-4009
Phone (512) 321-5437
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 260135218044 | Other | OH | CARE SOURCE |
| 2121196-01 | Medicaid | TX | |
| 2732289 | Medicaid | OH | |
| 9199964 | Other | OH | DORAL |
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 Nov 4, 2011. 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.