Individual provider Active NPI

Alissa Medina, DMD

  • General Practice Dentistry
  • Conroe, TX
National Provider Identifier
1679711444
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
26336 Issued in TX
Practice address
605 S Conroe Medical Dr
Conroe, TX 77304-4722
Phone
(936) 539-4004
Fax
(936) 521-3964
NPI assigned
Jan 31, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 26336 TX Primary

Addresses

Primary practice location

605 S Conroe Medical Dr
Conroe, TX 77304-4722

Mailing address

605 S Conroe Medical Dr
Conroe, TX 77304-4722
Phone (936) 539-4004

Other practice location 1

18230 Fm 1488 Rd Ste 203
Magnolia, TX 77354-4530
Phone (936) 539-4004

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160824002367 TX Order and Referring Only - DentistPractitioner - Dentist 6204121619

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26336TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lone Star Community Health Center, Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1679711444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-521-3964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722",
            "telephone_number": "936-539-4004",
            "fax_number": "936-521-3964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18230 Fm 1488 Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Magnolia",
            "state": "TX",
            "postal_code": "773544530",
            "country_code": "US",
            "telephone_number": "936-539-4004",
            "fax_number": "281-715-0558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ALISSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-31",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "26336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.