Provider Demographics
NPI:1982710307
Name:ESPELETA, EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:ESPELETA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:39209 WINCHESTER RD
Practice Address - Street 2:STE. 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3513
Practice Address - Country:US
Practice Address - Phone:951-304-1348
Practice Address - Fax:951-304-1357
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice