Provider Demographics
NPI:1740948520
Name:ESTRADA, LUIS FERNANDO (RDH)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 OAK RIM WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1506
Mailing Address - Country:US
Mailing Address - Phone:408-712-9135
Mailing Address - Fax:
Practice Address - Street 1:89 PUTNAM WAY
Practice Address - Street 2:
Practice Address - City:ARBUCKLE
Practice Address - State:CA
Practice Address - Zip Code:95912-9814
Practice Address - Country:US
Practice Address - Phone:530-476-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31205124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty