Individual provider Active NPI

Edgar Ivan Ledezma-Alvarez, DDS

  • Dentist
  • Galveston, TX
National Provider Identifier
1780308510
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
39063 Issued in TX
Practice address
6026 Seawall Blvd Ste B
Galveston, TX 77551-5866
Phone
(281) 827-5378
NPI assigned
Sep 26, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 39063 TX Primary

Addresses

Primary practice location

6026 Seawall Blvd Ste B
Galveston, TX 77551-5866

Mailing address

9230 Havenway LN
Houston, TX 77064-7732
Phone (281) 827-5378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
39063TXMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1780308510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9230 HAVENWAY LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770647732",
            "telephone_number": "281-827-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6026 SEAWALL BLVD STE B",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775515866",
            "telephone_number": "281-827-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEDEZMA-ALVAREZ",
        "first_name": "EDGAR",
        "middle_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "39063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.