Healthcare Provider Details

I. General information

NPI: 1134499551
Provider Name (Legal Business Name): SALLY ESQUIVEL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 7TH ST SUITE 2B
UPLAND CA
91786-6602
US

IV. Provider business mailing address

270 E 7TH ST SUITE 2B
UPLAND CA
91786-6602
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1211
  • Fax: 909-982-8482
Mailing address:
  • Phone: 909-985-1211
  • Fax: 909-982-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: