MEDICARE: CARLOS ESQUIVEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13863	TX

General Provider Information

NPI Number	:	1447326970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ESQUIVEL DDS

Provider Business Mailing Address
First Line	:	2143 BANDERA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228
Country	:	US
Telephone Number	:	210-436-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	4507 MEDICAL DR
Second Line	:	VILLA CORONADO CLINIC
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4401
Country	:	US
Telephone Number	:	210-683-4667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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