Provider Demographics
NPI:1972576130
Name:ESPARZA, OSCAR (DDS)
Entity type:Individual
Prefix:PROF
First Name:OSCAR
Middle Name:
Last Name:ESPARZA
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 1:213 W G STREET
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45252122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45252Medicaid
CA823041039OtherTAX IS NUMBER INC.
CA823041039OtherTAX IS NUMBER INC.