Provider Demographics
NPI:1578661773
Name:ESPINO, MARIAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:M
Last Name:ESPINO
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 1:9335 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4175
Mailing Address - Country:US
Mailing Address - Phone:219-836-2092
Mailing Address - Fax:219-836-9501
Practice Address - Street 1:9335 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4175
Practice Address - Country:US
Practice Address - Phone:219-836-2092
Practice Address - Fax:219-836-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009514A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice