Provider Demographics
NPI:1205385523
Name:ESCOBAR, JOSE (RDA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19472 TAHOKA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5299
Mailing Address - Country:US
Mailing Address - Phone:832-857-6707
Mailing Address - Fax:
Practice Address - Street 1:31315 FM 2920 RD STE 16A
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8022
Practice Address - Country:US
Practice Address - Phone:936-372-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35773126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant