Provider Demographics
NPI:1558461178
Name:LEDBETTER, ROY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:L
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:L
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:501 DANCE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-4019
Mailing Address - Country:US
Mailing Address - Phone:979-345-4355
Mailing Address - Fax:979-345-7168
Practice Address - Street 1:501 DANCE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-4019
Practice Address - Country:US
Practice Address - Phone:979-345-4355
Practice Address - Fax:979-345-7168
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist