Provider Demographics
NPI:1831326925
Name:ECKFORD, JOE EMBRY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:EMBRY
Last Name:ECKFORD
Suffix:JR
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 1:10019 S MAIN ST
Mailing Address - Street 2:A6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5256
Mailing Address - Country:US
Mailing Address - Phone:713-433-6431
Mailing Address - Fax:713-665-6432
Practice Address - Street 1:10019 S MAIN ST
Practice Address - Street 2:A6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-433-6431
Practice Address - Fax:713-665-6432
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25289122300000X, 332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211820007Medicaid