Provider Demographics
NPI:1639866791
Name:FONSECA ESPINOZA, ALMA DELIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ALMA
Middle Name:DELIA
Last Name:FONSECA ESPINOZA
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 1:3026 ISABELLA DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-8241
Mailing Address - Country:US
Mailing Address - Phone:240-936-0851
Mailing Address - Fax:
Practice Address - Street 1:3026 ISABELLA DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-8241
Practice Address - Country:US
Practice Address - Phone:240-936-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist