Healthcare Provider Details

I. General information

NPI: 1912452723
Provider Name (Legal Business Name): ESPARZA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 E PHILADELPHIA ST STE O
CHINO CA
91710-2483
US

IV. Provider business mailing address

5250 E PHILADELPHIA ST STE O
CHINO CA
91710-2483
US

V. Phone/Fax

Practice location:
  • Phone: 909-613-1300
  • Fax: 909-613-1302
Mailing address:
  • Phone: 909-613-1300
  • Fax: 909-613-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number41648
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. OSCAR B ESPARZA
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-613-1300