Provider Demographics
NPI:1538989355
Name:ESTEBAN ASCENCIO
Entity type:Organization
Organization Name:ESTEBAN ASCENCIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-352-0417
Mailing Address - Street 1:1219 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-1223
Mailing Address - Country:US
Mailing Address - Phone:562-352-0417
Mailing Address - Fax:562-366-0560
Practice Address - Street 1:2468 JOSE CLEMENTE OROZCO STE 403
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BC
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-252-6200
Practice Address - Fax:562-366-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty