Healthcare Provider Details

I. General information

NPI: 1760471270
Provider Name (Legal Business Name): JAMES STEPHEN EAVES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 WHITE WING CIR
FRIENDSWOOD TX
77546-5451
US

IV. Provider business mailing address

1714 WHITE WING CIR
FRIENDSWOOD TX
77546-5451
US

V. Phone/Fax

Practice location:
  • Phone: 832-551-4770
  • Fax:
Mailing address:
  • Phone: 832-551-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: