Provider Demographics
NPI:1619196318
Name:BUENAVENTURA, ESPERANZA (DDS)
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:
Last Name:BUENAVENTURA
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 1:9660 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3300
Mailing Address - Country:US
Mailing Address - Phone:661-272-9292
Mailing Address - Fax:661-272-8932
Practice Address - Street 1:38655 9TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3814
Practice Address - Country:US
Practice Address - Phone:661-272-9181
Practice Address - Fax:661-272-8932
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice