Provider Demographics
NPI:1528031788
Name:ESPARZA, BLANCA (DDS)
Entity Type:Individual
Prefix:PROF
First Name:BLANCA
Middle Name:
Last Name:ESPARZA
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 1:527 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3215
Mailing Address - Country:US
Mailing Address - Phone:909-984-3618
Mailing Address - Fax:909-984-9479
Practice Address - Street 1:213 W G ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3227
Practice Address - Country:US
Practice Address - Phone:909-986-6180
Practice Address - Fax:909-986-6179
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10442-1OtherBLUE SHIELD
CA786491OtherUNITED CONCORDIA
CAB41848-01Medicaid
CA786491OtherUNITED CONCORDIA