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General NPI Number Information
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NPI Number | 1821716317
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Entity Type | Organization
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Legal Business Name | DEREK ESPINO, D.M.D. PA
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 9332 BALM RIVERVIEW RD # NA
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City | RIVERVIEW
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State | FL
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Zip | 33569-5104
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Country | US
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Telephone | 813-677-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 9332 BALM RIVERVIEW RD # NA
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City | RIVERVIEW
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State | FL
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Zip | 33569-5104
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Country | US
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Telephone | 813-677-1177
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DEREK ESPINO
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Credential | D.M.D.
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Telephone | 813-677-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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