Provider Demographics
NPI:1548782600
Name:ESTENOZ, EMMY
Entity Type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:ESTENOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 BLACK OAK CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6605
Mailing Address - Country:US
Mailing Address - Phone:786-325-5761
Mailing Address - Fax:
Practice Address - Street 1:4825 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3944
Practice Address - Country:US
Practice Address - Phone:954-642-2203
Practice Address - Fax:954-532-2202
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice