Provider Demographics
NPI:1457652653
Name:ESCOBAR, ERIC A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:ESCOBAR
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 1:532 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1602
Mailing Address - Country:US
Mailing Address - Phone:775-786-6168
Mailing Address - Fax:775-786-6894
Practice Address - Street 1:532 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1602
Practice Address - Country:US
Practice Address - Phone:775-786-6168
Practice Address - Fax:775-786-6894
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice