Provider Demographics
NPI:1285021568
Name:MILLA ESCOBAR, KAREN YESENIA (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:YESENIA
Last Name:MILLA ESCOBAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 CRITTENDEN RD
Mailing Address - Street 2:APT #6
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1432
Mailing Address - Country:US
Mailing Address - Phone:678-650-1078
Mailing Address - Fax:
Practice Address - Street 1:1841 W RIDGE RD
Practice Address - Street 2:ERIE CANAL COMMONS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2504
Practice Address - Country:US
Practice Address - Phone:678-650-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058613-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice