Provider Demographics
NPI:1912452723
Name:ESPARZA DENTAL CORPORATION
Entity Type:Organization
Organization Name:ESPARZA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-613-1300
Mailing Address - Street 1:5250 E PHILADELPHIA ST
Mailing Address - Street 2:STE O
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2483
Mailing Address - Country:US
Mailing Address - Phone:909-613-1300
Mailing Address - Fax:909-613-1302
Practice Address - Street 1:5250 E PHILADELPHIA ST
Practice Address - Street 2:STE O
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2483
Practice Address - Country:US
Practice Address - Phone:909-613-1300
Practice Address - Fax:909-613-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223G0001X, 305R00000X
CA41648305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124382296OtherMEDICAL NPI