Provider Demographics
NPI:1528374766
Name:ESPARZA, HEIDI ESPARZA (RDH)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ESPARZA
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3793
Mailing Address - Country:US
Mailing Address - Phone:480-831-5200
Mailing Address - Fax:480-831-5290
Practice Address - Street 1:6655 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3793
Practice Address - Country:US
Practice Address - Phone:480-831-5200
Practice Address - Fax:480-831-5290
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6234124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist