Healthcare Provider Details

I. General information

NPI: 1396536678
Provider Name (Legal Business Name): CRYSTAL ITZAMAR HERNANDEZ ESTRADA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CEDAR BEND DR
HELENA AL
35080-3327
US

IV. Provider business mailing address

190 CEDAR BEND DR
HELENA AL
35080-3327
US

V. Phone/Fax

Practice location:
  • Phone: 334-859-7965
  • Fax:
Mailing address:
  • Phone: 334-859-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: