Provider Demographics
NPI:1881896371
Name:ESTRADA, JAIME (DDS)
Entity type:Individual
Prefix:
First Name:JAIME
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 1:13736 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8024
Mailing Address - Country:US
Mailing Address - Phone:727-869-3886
Mailing Address - Fax:727-868-9551
Practice Address - Street 1:13736 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8024
Practice Address - Country:US
Practice Address - Phone:727-869-3886
Practice Address - Fax:727-868-9551
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-158191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice