Provider Demographics
NPI:1093083156
Name:ESPINOSA, MARLING SUSANA
Entity Type:Individual
Prefix:DR
First Name:MARLING
Middle Name:SUSANA
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FERGUSON ST APT E1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2881
Mailing Address - Country:US
Mailing Address - Phone:973-870-8964
Mailing Address - Fax:
Practice Address - Street 1:56 FERGUSON ST APT E1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2881
Practice Address - Country:US
Practice Address - Phone:973-870-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055901-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice