Provider Demographics
NPI:1992403752
Name:LEDESMA, ERIKA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:LEIGH
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 TURNER WARNELL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7504
Mailing Address - Country:US
Mailing Address - Phone:817-312-1317
Mailing Address - Fax:
Practice Address - Street 1:1201 FM 1187 E STE 37
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4377
Practice Address - Country:US
Practice Address - Phone:817-618-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX396061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program