Provider Demographics
NPI:1043595903
Name:ESPINOZA, EDWARD JR (CD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:ESPINOZA
Suffix:JR
Gender:M
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 NE 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-7016
Mailing Address - Country:US
Mailing Address - Phone:503-252-9699
Mailing Address - Fax:503-252-9959
Practice Address - Street 1:206 NE 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-7016
Practice Address - Country:US
Practice Address - Phone:503-252-9699
Practice Address - Fax:503-252-9959
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR160122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist