MEDICARE: NICHOLAS D ESPLIN 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	122300000X	Dentist	25796	CA

General Provider Information

NPI Number	:	1841335460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS D ESPLIN DDS

Provider Business Mailing Address
First Line	:	301 ALAMO DRIVE
Second Line	:	SUITE F
City	:	VACAVILLE
State	:	CA
Zip	:	95688-4246
Country	:	US
Telephone Number	:	707-446-7480
Fax Number	:	707-449-4260

Provider Business Practice Location Address
First Line	:	301 ALAMO DRIVE
Second Line	:	SUITE F
City	:	VACAVILLE
State	:	CA
Zip	:	95688-4246
Country	:	US
Telephone Number	:	707-446-7480
Fax Number	:	707-449-4260

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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