Healthcare Provider Details

I. General information

NPI: 1649850892
Provider Name (Legal Business Name): ESGUERRA DENTAL IMPLANT ASSOCIATES OF DULUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 1212
DULUTH MN
55802-1712
US

IV. Provider business mailing address

324 W SUPERIOR ST STE 1212
DULUTH MN
55802-1712
US

V. Phone/Fax

Practice location:
  • Phone: 720-467-1726
  • Fax:
Mailing address:
  • Phone: 720-467-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROXANNA JEAN ESGUERRA
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 218-722-8118