=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386017085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZ SMILES DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 E ARKANSAS LN SUITE A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-6415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-478-5979
-----------------------------------------------------
Fax | 469-214-7789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 E ARKANSAS LN SUITE A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-6415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-478-5979
-----------------------------------------------------
Fax | 469-214-7789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REGINA G ESPINOZA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 818-370-1714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 31496
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 31496
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------