Provider Demographics
NPI:1497808737
Name:ESTRADA, CRAIG WAYNE TAMONDONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WAYNE TAMONDONG
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 1:1354 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
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA699529OtherUNITED CONCORDIA PROVIDER
VA323926OtherANTHEM PROVIDER ID