Provider Demographics
NPI:1821716317
Name:DEREK ESPINO, D.M.D. PA
Entity Type:Organization
Organization Name:DEREK ESPINO, D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-677-1177
Mailing Address - Street 1:9332 BALM RIVERVIEW RD # NA
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5104
Mailing Address - Country:US
Mailing Address - Phone:813-677-1177
Mailing Address - Fax:
Practice Address - Street 1:9332 BALM RIVERVIEW RD # NA
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5104
Practice Address - Country:US
Practice Address - Phone:813-677-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental