Provider Demographics
NPI:1477106557
Name:ESTELLA, BRAN'D HUTALLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAN'D
Middle Name:HUTALLA
Last Name:ESTELLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16733 LA VEDA AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1723
Mailing Address - Country:US
Mailing Address - Phone:323-369-8228
Mailing Address - Fax:
Practice Address - Street 1:540 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3010
Practice Address - Country:US
Practice Address - Phone:661-402-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist