Provider Demographics
NPI:1134536188
Name:LUZ E ESTRADA PLLC
Entity type:Organization
Organization Name:LUZ E ESTRADA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-544-6727
Mailing Address - Street 1:6104 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6283
Mailing Address - Country:US
Mailing Address - Phone:919-544-6727
Mailing Address - Fax:919-484-1434
Practice Address - Street 1:6104 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6283
Practice Address - Country:US
Practice Address - Phone:919-544-6727
Practice Address - Fax:919-484-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911620Medicaid