Provider Demographics
NPI:1093987026
Name:MARIA GLORIA ESTIPONA,D.D.S.,INC.
Entity Type:Organization
Organization Name:MARIA GLORIA ESTIPONA,D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTIPONA
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:408-933-8330
Mailing Address - Street 1:410 TERRA MESA WAY
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-2440
Mailing Address - Country:US
Mailing Address - Phone:408-933-8330
Mailing Address - Fax:
Practice Address - Street 1:1725 IRON POINT ROAD
Practice Address - Street 2:150
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:408-933-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty