Healthcare Provider Details

I. General information

NPI: 1174455372
Provider Name (Legal Business Name): ADAM R YBARRA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 OLD AUSTIN HWY STE 400
BASTROP TX
78602-5165
US

IV. Provider business mailing address

715 OLD AUSTIN HWY STE 400
BASTROP TX
78602-5165
US

V. Phone/Fax

Practice location:
  • Phone: 151-221-2980
  • Fax:
Mailing address:
  • Phone: 512-212-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: