Provider Demographics
NPI:1578827648
Name:ESPARZA DENTISTRY
Entity Type:Organization
Organization Name:ESPARZA DENTISTRY
Other - Org Name:BLANCA M. ESPARZA D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-986-6180
Mailing Address - Street 1:213 W G STREET
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3227
Mailing Address - Country:US
Mailing Address - Phone:909-986-6180
Mailing Address - Fax:909-984-9479
Practice Address - Street 1:213 W G STREET
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:909-984-9479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45252Medicaid
CAB41648-01Medicaid