Provider Demographics
NPI:1194498444
Name:PASTORES, REGINALD DWIGHT ESPINOZA (DMD)
Entity type:Individual
Prefix:
First Name:REGINALD DWIGHT
Middle Name:ESPINOZA
Last Name:PASTORES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7766
Mailing Address - Country:US
Mailing Address - Phone:832-898-2606
Mailing Address - Fax:
Practice Address - Street 1:304 VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7766
Practice Address - Country:US
Practice Address - Phone:832-898-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1066661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice