Provider Demographics
NPI:1104919299
Name:ECHOLS, BOBBY R (DDS)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:R
Last Name:ECHOLS
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 1:22200 W 11 MILE RD UNIT 238
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-7009
Mailing Address - Country:US
Mailing Address - Phone:248-388-8408
Mailing Address - Fax:
Practice Address - Street 1:3225 JOHN CONLEY DR
Practice Address - Street 2:THUMB CORRECTIONAL FACILITY
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2987
Practice Address - Country:US
Practice Address - Phone:810-667-2045
Practice Address - Fax:810-667-6732
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist