Provider Demographics
NPI:1659672145
Name:ESTRADA, KRISTEN MERCEDES (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MERCEDES
Last Name:ESTRADA
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 1:315 ALVAREZ DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1405
Mailing Address - Country:US
Mailing Address - Phone:575-571-3745
Mailing Address - Fax:
Practice Address - Street 1:315 ALVAREZ DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1405
Practice Address - Country:US
Practice Address - Phone:575-571-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist