Provider Demographics
NPI:1326616814
Name:L'ESPERANCE, NATHAN OLIVER (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:OLIVER
Last Name:L'ESPERANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 FEDERAL AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3926
Mailing Address - Country:US
Mailing Address - Phone:505-429-6034
Mailing Address - Fax:
Practice Address - Street 1:1104 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3512
Practice Address - Country:US
Practice Address - Phone:310-366-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1079531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program