Provider Demographics
NPI:1962957704
Name:ESPARZA DENTAL CORPORATION
Entity type:Organization
Organization Name:ESPARZA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-984-3418
Mailing Address - Street 1:213 W G ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3227
Mailing Address - Country:US
Mailing Address - Phone:909-986-6180
Mailing Address - Fax:909-986-6179
Practice Address - Street 1:213 W G ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3227
Practice Address - Country:US
Practice Address - Phone:909-986-6180
Practice Address - Fax:909-986-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45252305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912452723OtherMEDICAL NPI
CA1124382296OtherMEDICAL NPI