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General NPI Number Information
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NPI Number | 1740632645
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Entity Type | Individual
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Provider Name | MAIRA ESTRADA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 2222 E COUNTY ROAD 540A
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City | LAKELAND
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State | FL
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Zip | 33813-3825
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Country | US
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Telephone | 863-644-4687
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Fax | 863-644-4665
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Provider Business Mailing Address
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Address Line | 2222 E COUNTY ROAD 540A
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City | LAKELAND
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State | FL
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Zip | 33813-3825
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Country | US
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Telephone | 863-644-4687
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Fax | 863-644-4665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN21980
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License Number State | FL
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