Provider Demographics
NPI:1962527481
Name:ADJAN, JAMES FARRIS (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FARRIS
Last Name:ADJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4009
Mailing Address - Country:US
Mailing Address - Phone:512-321-5437
Mailing Address - Fax:888-317-1936
Practice Address - Street 1:696 HIGHWAY 71 W
Practice Address - Street 2:SUITE 4D
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4009
Practice Address - Country:US
Practice Address - Phone:512-321-5437
Practice Address - Fax:888-317-1936
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300223641223G0001X
TX253511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260135218044OtherCARE SOURCE
TX2121196-01Medicaid
OH2732289Medicaid
OH9199964OtherDORAL