Provider Demographics
NPI:1699045989
Name:EUGENE V ESPIRITU, DMD PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:EUGENE V ESPIRITU, DMD PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:VELARDE
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-875-6808
Mailing Address - Street 1:1230 EL CAMINO REAL STE K
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1300
Mailing Address - Country:US
Mailing Address - Phone:650-875-6808
Mailing Address - Fax:650-875-3755
Practice Address - Street 1:1230 EL CAMINO REAL STE K
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1300
Practice Address - Country:US
Practice Address - Phone:650-875-6808
Practice Address - Fax:650-875-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB33758-01OtherDELTA STATE GOVT PROGRAM
CA775195OtherUNITED CONCORDIA
CA143260OtherUNITED HEALTHCARE