Provider Demographics
NPI:1306378146
Name:ESTRADA, MANUEL ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14801 SW 194TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2204
Mailing Address - Country:US
Mailing Address - Phone:305-607-7877
Mailing Address - Fax:
Practice Address - Street 1:1201 N FEDERAL HWY STE 2D
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1457
Practice Address - Country:US
Practice Address - Phone:954-566-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN228451223G0001X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program