Healthcare Provider Details

I. General information

NPI: 1134647209
Provider Name (Legal Business Name): LAURIE M. ESTES, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 SAN PABLO AVE
ALBANY CA
94706-1126
US

IV. Provider business mailing address

591 SAN PABLO AVE
ALBANY CA
94706-1126
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-1772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS62336
License Number StateCA

VIII. Authorized Official

Name: DR. LAURIE MCCULLOUGH ESTES
Title or Position: PRESIDENT
Credential: DDS, MSD
Phone: 925-286-6055