Provider Demographics
NPI:1255430708
Name:DE JESUS, ANA LIZA ESPIRITU (DMD)
Entity type:Individual
Prefix:DR
First Name:ANA LIZA
Middle Name:ESPIRITU
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11450 FALLINGSTAR CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9251
Mailing Address - Country:US
Mailing Address - Phone:909-945-2661
Mailing Address - Fax:
Practice Address - Street 1:11450 FALLINGSTAR CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9251
Practice Address - Country:US
Practice Address - Phone:909-945-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice