Provider Demographics
NPI:1649850892
Name:ESGUERRA DENTAL IMPLANT ASSOCIATES OF DULUTH
Entity type:Organization
Organization Name:ESGUERRA DENTAL IMPLANT ASSOCIATES OF DULUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ESGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:218-722-8118
Mailing Address - Street 1:324 W SUPERIOR ST STE 1212
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1712
Mailing Address - Country:US
Mailing Address - Phone:720-467-1726
Mailing Address - Fax:
Practice Address - Street 1:324 W SUPERIOR ST STE 1212
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1712
Practice Address - Country:US
Practice Address - Phone:720-467-1726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty