1124382296 NPI number — ESPARZA DENTISTRY INC.

Table of content: (NPI 1124382296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124382296 NPI number — ESPARZA DENTISTRY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPARZA DENTISTRY INC.
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:
BLANCA M. ESPARZA D.D.S.
Provider Other Organization Name Type Code:
4
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:
1124382296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
786 E FOOTHILL BLVD
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
RIALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92376-5285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-874-7870
Provider Business Mailing Address Fax Number:
909-986-6179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
786 E FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
RIALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92376-5285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-874-7870
Provider Business Practice Location Address Fax Number:
909-986-6179
Provider Enumeration Date:
07/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ESPARZA
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-874-7870

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D45252-02 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B41648-02 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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