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General NPI Number Information
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NPI Number | 1912452723
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Entity Type | Organization
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Legal Business Name | ESPARZA DENTAL CORPORATION
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 5250 E PHILADELPHIA ST STE O
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City | CHINO
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State | CA
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Zip | 91710-2483
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Country | US
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Telephone | 909-613-1300
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Fax | 909-613-1302
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Provider Business Mailing Address
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Address Line | 5250 E PHILADELPHIA ST STE O
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City | CHINO
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State | CA
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Zip | 91710-2483
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Country | US
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Telephone | 909-613-1300
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Fax | 909-613-1302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSCAR B ESPARZA
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Credential | DDS
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Telephone | 909-613-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 41648
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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