Healthcare Provider Details

I. General information

NPI: 1700033248
Provider Name (Legal Business Name): MARK A. ESPINAL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 DAVE LYLE BLVD SUITE 100
ROCK HILL SC
29730-7939
US

IV. Provider business mailing address

2391 DAVE LYLE BLVD SUITE 100
ROCK HILL SC
29730-7939
US

V. Phone/Fax

Practice location:
  • Phone: 803-325-9000
  • Fax:
Mailing address:
  • Phone: 803-325-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4520
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: