MEDICARE: PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry	23479	TX
2	1223P0221X	Pediatric Dentistry	11647	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720472707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	1318 E LANE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-7211
Country	:	US
Telephone Number	:	956-724-2712
Fax Number	:	956-724-2714

Provider Business Practice Location Address
First Line	:	1318 E LANE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-7211
Country	:	US
Telephone Number	:	956-724-2712
Fax Number	:	956-724-2714

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. FELIPE H ESPARZA
Credential	:	DDS, MPH
Telephone Number	:	956-724-2712

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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Directions to “PEDIATRIC DENTISTRY ” Practice Location

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