Provider Demographics
NPI:1922185164
Name:ESCOBAR, MAYRA ELIZABETH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:ESCOBAR
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 1:642 PARKVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1528
Mailing Address - Country:US
Mailing Address - Phone:650-451-8206
Mailing Address - Fax:
Practice Address - Street 1:155 BIRCH ST
Practice Address - Street 2:STE #3
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-261-9834
Practice Address - Fax:650-261-9835
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist