Provider Demographics
NPI:1114214285
Name:HOEDEBECKE, AMBER LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LEE
Last Name:HOEDEBECKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:LEE
Other - Last Name:TODORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:210-277-6387
Practice Address - Street 1:3066 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-1013
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:210-277-6387
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156431OtherMEDICARE PTAN