Active NPI
Houssam Eddin Alghadban, DDS
- Periodontics
- San Antonio, TX
National Provider Identifier
1154557072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 24797
- Practice address
- 18850 Stone Oak Pkwy
San Antonio, TX 78258-4113 - Phone
- (210) 402-9655
- NPI assigned
- Jun 5, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | S-461 | LA | |
| Periodontics | 1223P0300X | 24797 | TX | Primary |
Addresses
Primary practice location
18850 Stone Oak Pkwy
San Antonio, TX 78258-4113
Mailing address
18850 Stone Oak Pkwy
San Antonio, TX 78258-4113
Phone (321) 947-0919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321001605 | TX | Order and Referring Only - Dentist | 7719290444 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S-461 | LA | MD | Periodontist |
| 24797 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1154557072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18850 STONE OAK PKWY",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584113",
"telephone_number": "321-947-0919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18850 STONE OAK PKWY",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584113",
"telephone_number": "210-402-9655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALGHADBAN",
"first_name": "HOUSSAM",
"middle_name": "EDDIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-05",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "LA",
"license": "S-461",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "24797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.