Healthcare Provider Details

I. General information

NPI: 1770078313
Provider Name (Legal Business Name): DAVID E ECCKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # D202
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

7533 THORNWOOD DR NW
ALBUQUERQUE NM
87120-4551
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6525
  • Fax: 859-257-8584
Mailing address:
  • Phone: 619-212-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10854
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4907
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10854
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: