Healthcare Provider Details

I. General information

NPI: 1497326953
Provider Name (Legal Business Name): JOSE LUIS ESTRADA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MARKET ST
ALAMOSA CO
81101-2290
US

IV. Provider business mailing address

1500 N GRANT ST # 5218
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-9691
  • Fax:
Mailing address:
  • Phone: 720-248-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00204823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: