MEDICARE: ROBERT D. ESPARZA, DDS, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1265852842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D. ESPARZA, DDS, PC

Provider Business Mailing Address
First Line	:	1901 S MAIN ST
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-5120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 S MAIN ST
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-5120
Country	:	US
Telephone Number	:	817-337-1658
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	KENDRA WALKER
Credential	:
Telephone Number	:	217-540-8312

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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