Provider Demographics
NPI:1790805141
Name:JUAN C ECHEVERN DDS PROFESSIONAL CORP
Entity Type:Organization
Organization Name:JUAN C ECHEVERN DDS PROFESSIONAL CORP
Other - Org Name:ECHEVERRI DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ECHEVERRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-956-8767
Mailing Address - Street 1:7844 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3621
Mailing Address - Country:US
Mailing Address - Phone:713-956-8767
Mailing Address - Fax:713-956-1952
Practice Address - Street 1:7844 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3621
Practice Address - Country:US
Practice Address - Phone:713-956-8767
Practice Address - Fax:713-956-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126742905Medicaid