Provider Demographics
NPI:1407239619
Name:ESPINOSA, ERNESTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:ESPINOSA
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 1:784 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2407
Mailing Address - Country:US
Mailing Address - Phone:262-673-2288
Mailing Address - Fax:
Practice Address - Street 1:784 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2407
Practice Address - Country:US
Practice Address - Phone:262-673-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001150-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist