Healthcare Provider Details

I. General information

NPI: 1720359466
Provider Name (Legal Business Name): ESQUIVEL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50054
License Number StateCA

VIII. Authorized Official

Name: DR. SALLY ESQUIVEL
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 909-985-1211