Provider Demographics
NPI:1194113506
Name:ESPERANZA DENTAL CLINIC LLC
Entity type:Organization
Organization Name:ESPERANZA DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ESPERANZA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:602-368-4050
Mailing Address - Street 1:10636 N 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4057
Mailing Address - Country:US
Mailing Address - Phone:602-465-0459
Mailing Address - Fax:
Practice Address - Street 1:321 W HATCHER RD STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2400
Practice Address - Country:US
Practice Address - Phone:602-368-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6723251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12400000XOtherDENTAL HYGIENIST