Provider Demographics
NPI:1710726567
Name:SANTANA ESPESO, LUIS ERNESTO (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:SANTANA ESPESO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BELMONT AVE APT 526
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3766
Mailing Address - Country:US
Mailing Address - Phone:305-834-9518
Mailing Address - Fax:
Practice Address - Street 1:165 BELMONT AVE APT 526
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3766
Practice Address - Country:US
Practice Address - Phone:305-834-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03035300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist