Provider Demographics
NPI:1770521353
Name:MARQUEZ, ESTELLA AUSTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:ESTELLA
Middle Name:AUSTINE
Last Name:MARQUEZ
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 1:2040 FAIR PARK AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1988
Mailing Address - Country:US
Mailing Address - Phone:323-257-0731
Mailing Address - Fax:
Practice Address - Street 1:1201 N PACIFIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3824
Practice Address - Country:US
Practice Address - Phone:818-815-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice