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General NPI Number Information
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NPI Number | 1093074189
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Entity Type | Organization
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Legal Business Name | ESTRADA & ESTRADA, PC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 1354 KEMPSVILLE RD ST. 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-548-1611
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Fax | 757-548-1051
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Provider Business Mailing Address
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Address Line | 1354 KEMPSVILLE RD ST. 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-548-1611
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Fax | 757-548-1051
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CRAIG W.T. ESTRADA
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Credential | DDS
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Telephone | 757-548-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 007715
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 410774
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 006969
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License Number State | VA
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