Healthcare Provider Details

I. General information

NPI: 1528031788
Provider Name (Legal Business Name): BLANCA ESPARZA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W G ST
ONTARIO CA
91762-3227
US

IV. Provider business mailing address

527 N PALM AVE
ONTARIO CA
91762-3215
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-6180
  • Fax: 909-986-6179
Mailing address:
  • Phone: 909-984-3618
  • Fax: 909-984-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: