Healthcare Provider Details

I. General information

NPI: 1295520500
Provider Name (Legal Business Name): ESPANA-AUSTIN PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 NE 11TH ST STE 125
RENTON WA
98056-3410
US

IV. Provider business mailing address

2955 NE 11TH ST STE 125
RENTON WA
98056-3410
US

V. Phone/Fax

Practice location:
  • Phone: 971-279-6620
  • Fax:
Mailing address:
  • Phone: 971-279-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BARTOLO ESPANA-AUSTIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 971-279-6620