Provider Demographics
NPI:1962535047
Name:ESPINOSA, J. KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:KEITH
Last Name:ESPINOSA
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 1:17 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3535
Mailing Address - Country:US
Mailing Address - Phone:973-383-7900
Mailing Address - Fax:973-300-5766
Practice Address - Street 1:183 HIGH ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9601
Practice Address - Country:US
Practice Address - Phone:973-383-7900
Practice Address - Fax:973-300-5766
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1017823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist