Provider Demographics
NPI:1609934918
Name:DECASTECKER, ESTELA VIVIANA (DDS)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:VIVIANA
Last Name:DECASTECKER
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 1:32560 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-6302
Mailing Address - Country:US
Mailing Address - Phone:440-542-0137
Mailing Address - Fax:
Practice Address - Street 1:7320 INDUSTRIAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5318
Practice Address - Country:US
Practice Address - Phone:440-975-9885
Practice Address - Fax:440-975-1634
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206521223G0001X
OH30.0206521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice