Provider Demographics
NPI:1437516507
Name:MARK A ESPINOZA DDS PLLC
Entity Type:Organization
Organization Name:MARK A ESPINOZA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-943-7297
Mailing Address - Street 1:9315 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2417
Mailing Address - Country:US
Mailing Address - Phone:602-943-7297
Mailing Address - Fax:602-944-2395
Practice Address - Street 1:9315 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2417
Practice Address - Country:US
Practice Address - Phone:602-943-7297
Practice Address - Fax:602-944-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD046151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty