Provider Demographics
NPI:1235417858
Name:ESTES, LAURIE MCCULLOUGH (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MCCULLOUGH
Last Name:ESTES
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:LAURIE
Other - Middle Name:KATHARINE
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:591 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1126
Mailing Address - Country:US
Mailing Address - Phone:510-525-1772
Mailing Address - Fax:510-525-3157
Practice Address - Street 1:591 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1126
Practice Address - Country:US
Practice Address - Phone:510-525-1772
Practice Address - Fax:510-525-3157
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS623361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty