1942545215 NPI number — EJIRO ESI DDS PC

Table of content: (NPI 1942545215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942545215 NPI number — EJIRO ESI DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EJIRO ESI DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ESI ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942545215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2720 S ARLINGTON MILL DR UNIT 711
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22206-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 NATIONAL DR
Provider Second Line Business Practice Location Address:
150
Provider Business Practice Location Address City Name:
BURTONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20866-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-245-0540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESI
Authorized Official First Name:
EJIRO
Authorized Official Middle Name:
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
240-245-0540

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  13248 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)