Healthcare Provider Details

I. General information

NPI: 1831955087
Provider Name (Legal Business Name): RICHARD RALPH ESCOBAR DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 1ST AVE N
ST PETERSBURG FL
33710-7913
US

IV. Provider business mailing address

416 S PALOMA PL
TAMPA FL
33609-3712
US

V. Phone/Fax

Practice location:
  • Phone: 727-381-1062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN26166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: