Provider Demographics
NPI:1124020235
Name:ESTELLE, LASAUNDRA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LASAUNDRA
Middle Name:C
Last Name:ESTELLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 46TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:212-426-3790
Mailing Address - Fax:212-682-3501
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:STE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
Practice Address - Country:US
Practice Address - Phone:212-426-3790
Practice Address - Fax:212-682-3501
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685610Medicaid