Provider Demographics
NPI:1609097799
Name:ESPEJO, LUCRECIA GLORIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCRECIA
Middle Name:GLORIA
Last Name:ESPEJO
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 1:6 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2040
Mailing Address - Country:US
Mailing Address - Phone:415-456-1721
Mailing Address - Fax:415-456-1441
Practice Address - Street 1:6 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2040
Practice Address - Country:US
Practice Address - Phone:415-456-1721
Practice Address - Fax:415-456-1441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice