Provider Demographics
NPI:1851587158
Name:ESPINDOLA, FABIANA MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:FABIANA
Middle Name:MARIA
Last Name:ESPINDOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:FABIANA
Other - Middle Name:
Other - Last Name:ESPINDOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:5202 S DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3721
Mailing Address - Country:US
Mailing Address - Phone:773-677-7903
Mailing Address - Fax:
Practice Address - Street 1:6153 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-2047
Practice Address - Country:US
Practice Address - Phone:773-677-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 181461223G0001X
IL0190278491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice