Provider Demographics
NPI:1629648860
Name:HUTALLA ESTELLA DENTAL CORP.
Entity Type:Organization
Organization Name:HUTALLA ESTELLA DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAN'D
Authorized Official - Middle Name:HUTALLA
Authorized Official - Last Name:ESTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-369-8228
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:
Mailing Address - Fax:
Practice Address - Street 1:540 W RANCHO VISTA BLVD STE 102
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:661-402-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental