Provider Demographics
NPI:1144356064
Name:ROBERTO V ESPEJO JR DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ROBERTO V ESPEJO JR DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:V
Authorized Official - Last Name:ESPEJO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-466-0191
Mailing Address - Street 1:222 E ACACIA STREET
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202
Mailing Address - Country:US
Mailing Address - Phone:209-466-0191
Mailing Address - Fax:209-466-3565
Practice Address - Street 1:222 E ACACIA STREET
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:209-466-0191
Practice Address - Fax:209-466-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty