Healthcare Provider Details

I. General information

NPI: 1306931035
Provider Name (Legal Business Name): HENRY D ESPINOSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE #203
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

10409 MONTGOMERY PKW NE #203
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1116
  • Fax: 505-888-1119
Mailing address:
  • Phone: 505-888-1116
  • Fax: 505-888-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDD1235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: