Provider Demographics
NPI:1194715425
Name:ESPAILLAT, JUAN BAUTISTA (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:BAUTISTA
Last Name:ESPAILLAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 N MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3749
Mailing Address - Country:US
Mailing Address - Phone:845-426-1619
Mailing Address - Fax:845-371-2694
Practice Address - Street 1:286 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3749
Practice Address - Country:US
Practice Address - Phone:845-426-1619
Practice Address - Fax:845-371-2694
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411952Medicaid