Provider Demographics
NPI:1457724049
Name:ESPINA ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:ESPINA ORTHODONTICS, PLLC
Other - Org Name:EL PASO FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEININ
Authorized Official - Last Name:ESPINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-588-0975
Mailing Address - Street 1:7211 N MESA ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3606
Mailing Address - Country:US
Mailing Address - Phone:915-588-0975
Mailing Address - Fax:
Practice Address - Street 1:4504 PARADE WILLOW DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-2235
Practice Address - Country:US
Practice Address - Phone:915-588-0978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid
TX=========OtherPRIVATE INSURANCES