Provider Demographics
NPI:1710025598
Name:LEDWIG, STEVEN EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDMUND
Last Name:LEDWIG
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 1:1583 THOUSAND OAKS DR
Mailing Address - Street 2:SUITE # 117
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2300
Mailing Address - Country:US
Mailing Address - Phone:210-495-5023
Mailing Address - Fax:210-490-0354
Practice Address - Street 1:1583 THOUSAND OAKS DR
Practice Address - Street 2:SUITE # 117
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2300
Practice Address - Country:US
Practice Address - Phone:210-495-5023
Practice Address - Fax:210-490-0354
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1584898-01Medicaid