Provider Demographics
NPI:1194081182
Name:ADATIA, ANAND (DMD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:ADATIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MUELLER BLVD
Mailing Address - Street 2:UNIT 2022
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:630-362-0154
Mailing Address - Fax:
Practice Address - Street 1:11100 PARKFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4263
Practice Address - Country:US
Practice Address - Phone:512-339-7848
Practice Address - Fax:512-339-7862
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028842122300000X
TX294491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist