Provider Demographics
NPI:1376769281
Name:ECCLES, SCOTT FRAZIER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:FRAZIER
Last Name:ECCLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13831 KINGSRIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3312
Mailing Address - Country:US
Mailing Address - Phone:281-589-1516
Mailing Address - Fax:
Practice Address - Street 1:1000 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-1608
Practice Address - Country:US
Practice Address - Phone:713-783-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice