Healthcare Provider Details

I. General information

NPI: 1598158347
Provider Name (Legal Business Name): GLACENDY ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLACENDY ESPINOSA DDS

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 3RD AVE
NEW YORK NY
10016-6021
US

IV. Provider business mailing address

14115 14TH AVE
WHITESTONE NY
11357-2327
US

V. Phone/Fax

Practice location:
  • Phone: 646-729-4583
  • Fax:
Mailing address:
  • Phone: 646-729-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: