MEDICARE: DR. FELIPE HEBERTO ESPARZA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	11647	TX

General Provider Information

NPI Number	:	1154327344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELIPE HEBERTO ESPARZA D.D.S.

Provider Business Mailing Address
First Line	:	1320 E LANE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-7211
Country	:	US
Telephone Number	:	956-724-2712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1318 E LANE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-7211
Country	:	US
Telephone Number	:	956-724-2712
Fax Number	:	956-724-2714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/09/2007

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