Provider Demographics
NPI:1083754337
Name:ESCALA, ERNESTO ENRIQUE
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ENRIQUE
Last Name:ESCALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8926
Mailing Address - Country:US
Mailing Address - Phone:520-743-3350
Mailing Address - Fax:
Practice Address - Street 1:5723 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2401
Practice Address - Country:US
Practice Address - Phone:520-514-7400
Practice Address - Fax:520-514-7403
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist