MEDICARE: ELIZABETH M ESTRADA DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1104599091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH M ESTRADA DDS PC

Provider Business Mailing Address
First Line	:	7300 TOPANGA CANYON BLVD STE 6
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3333
Country	:	US
Telephone Number	:	747-444-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 TOPANGA CANYON BLVD STE 6
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3333
Country	:	US
Telephone Number	:	747-444-9090
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELIZABETH ESTRADA
Credential	:	DDS
Telephone Number	:	747-444-9090

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	11/20/2021

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