Provider Demographics
NPI:1003956822
Name:ESTRADA, JAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
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 1:646 W PALM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3210
Mailing Address - Country:US
Mailing Address - Phone:305-242-1200
Mailing Address - Fax:305-242-8782
Practice Address - Street 1:646 W PALM DR STE 200
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3210
Practice Address - Country:US
Practice Address - Phone:305-242-1200
Practice Address - Fax:305-242-8782
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6509630821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0014847OtherGENERAL DENTISTRY
FL0014741OtherGENERAL DENTISTRY
FL0014560OtherGENERAL DENTRISTRY