Provider Demographics
NPI:1447439039
Name:ESCAMILLO, ALEX JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JAMES
Last Name:ESCAMILLO
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 1:4968 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1443
Mailing Address - Country:US
Mailing Address - Phone:951-683-0174
Mailing Address - Fax:951-683-3794
Practice Address - Street 1:4968 ROCKLEDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1443
Practice Address - Country:US
Practice Address - Phone:951-683-0174
Practice Address - Fax:951-683-3794
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice