Provider Demographics
NPI:1477923449
Name:ESTEDRAK, MARYZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYZ
Middle Name:
Last Name:ESTEDRAK
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 1:479 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5597
Mailing Address - Country:US
Mailing Address - Phone:201-467-7414
Mailing Address - Fax:
Practice Address - Street 1:479 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5597
Practice Address - Country:US
Practice Address - Phone:201-467-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02622100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist