Provider Demographics
NPI:1124382296
Name:ESPARZA DENTISTRY INC.
Entity Type:Organization
Organization Name:ESPARZA DENTISTRY INC.
Other - Org Name:BLANCA M. ESPARZA D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-874-7870
Mailing Address - Street 1:786 E FOOTHILL BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5285
Mailing Address - Country:US
Mailing Address - Phone:909-874-7870
Mailing Address - Fax:909-986-6179
Practice Address - Street 1:786 E FOOTHILL BLVD
Practice Address - Street 2:STE D
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5285
Practice Address - Country:US
Practice Address - Phone:909-874-7870
Practice Address - Fax:909-986-6179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESPARZA DENTISTRY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-03
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45252-02Medicaid
CAB41648-02Medicaid