Provider Demographics
NPI:1255336186
Name:ECHEVERRI, JUAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:ECHEVERRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX169021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126742902Medicaid