Provider Demographics
NPI:1609974989
Name:ALVAREZ, CEDRIC LEE (DDS)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:LEE
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 AUTRY POND STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2097
Mailing Address - Country:US
Mailing Address - Phone:210-396-7667
Mailing Address - Fax:210-396-7556
Practice Address - Street 1:17230 AUTRY POND STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2097
Practice Address - Country:US
Practice Address - Phone:210-396-7667
Practice Address - Fax:210-396-7556
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1796880-04Medicaid