Provider Demographics
NPI:1760073407
Name:ESQUIVEL D.D.S. DENTAL CORPORATION
Entity Type:Organization
Organization Name:ESQUIVEL D.D.S. DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-590-9470
Mailing Address - Street 1:410 S GLENDORA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6239
Mailing Address - Country:US
Mailing Address - Phone:626-963-4464
Mailing Address - Fax:
Practice Address - Street 1:410 S GLENDORA AVE STE 250
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6239
Practice Address - Country:US
Practice Address - Phone:626-963-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty