Healthcare Provider Details

I. General information

NPI: 1609511534
Provider Name (Legal Business Name): JOLEE DAGAMAC ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5752 PALMER PARK BLVD
COLORADO SPRINGS CO
80915-1511
US

IV. Provider business mailing address

5752 PALMER PARK BLVD
COLORADO SPRINGS CO
80915-1511
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-0827
  • Fax: 719-645-8432
Mailing address:
  • Phone: 719-445-0827
  • Fax: 719-645-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00205279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: