Healthcare Provider Details

I. General information

NPI: 1306312863
Provider Name (Legal Business Name): MARK A ESPINOZA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9242 N 7TH ST
PHOENIX AZ
85020-2502
US

IV. Provider business mailing address

9242 N 7TH ST
PHOENIX AZ
85020-2502
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-7297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA CALABRESE
Title or Position: ACCOUNTING DEPARTMENT
Credential:
Phone: 440-317-1292