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: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7903 SILICON HTS
COLORADO SPRINGS CO
80939-9734
US

IV. Provider business mailing address

7903 SILICON HTS
COLORADO SPRINGS CO
80939-9734
US

V. Phone/Fax

Practice location:
  • Phone: 719-354-2900
  • Fax: 720-861-4052
Mailing address:
  • Phone: 719-354-2900
  • Fax: 720-861-4052

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: