Healthcare Provider Details

I. General information

NPI: 1992271787
Provider Name (Legal Business Name): ESPARZA DENTISTRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 11/01/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W G ST
ONTARIO CA
91762-3227
US

IV. Provider business mailing address

213 W G ST
ONTARIO CA
91762-3227
US

V. Phone/Fax

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

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: DR. OSCAR ESPARZA
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 909-986-6180