Provider Demographics
NPI:1992059653
Name:ESPINOZA, BRITTNEY (DDS)
Entity type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
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:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1190
Mailing Address - Country:US
Mailing Address - Phone:307-733-2555
Mailing Address - Fax:
Practice Address - Street 1:200 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8634
Practice Address - Country:US
Practice Address - Phone:307-733-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27965122300000X
WY1374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1374OtherWY LICENSE
TX27965OtherDDS