Healthcare Provider Details

I. General information

NPI: 1376769281
Provider Name (Legal Business Name): SCOTT FRAZIER ECCLES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WILCREST DR
HOUSTON TX
77042-1608
US

IV. Provider business mailing address

13831 KINGSRIDE LN
HOUSTON TX
77079-3312
US

V. Phone/Fax

Practice location:
  • Phone: 713-783-3355
  • Fax:
Mailing address:
  • Phone: 281-589-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20386
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: