Provider Demographics
NPI:1417146044
Name:ESTRADA & ESTRADA, PC
Entity Type:Organization
Organization Name:ESTRADA & ESTRADA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WT
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-548-1611
Mailing Address - Street 1:1354 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1416
Mailing Address - Country:US
Mailing Address - Phone:757-548-1611
Mailing Address - Fax:757-548-1051
Practice Address - Street 1:1354 KEMPSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1416
Practice Address - Country:US
Practice Address - Phone:757-548-1611
Practice Address - Fax:757-548-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA069691223G0001X
VA077151223G0001X
VA107741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275686511OtherDENTAL
VA1194705111OtherDENTAL
VA1497808737OtherDENTAL