MEDICARE: BARTOLO ESPANA-AUSTIN

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	261QD0000X	Dental Clinic/Center	30426	TX

General Provider Information

NPI Number	:	1588066229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTOLO ESPANA-AUSTIN

Provider Business Mailing Address
First Line	:	5208 WESTLEIGH AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3322
Country	:	US
Telephone Number	:	702-408-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 WESTLEIGH AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3322
Country	:	US
Telephone Number	:	702-408-8322
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	BARTOLO ESPANA-AUSTIN
Credential	:	D.D.S.
Telephone Number	:	702-408-8322

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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