Provider Demographics
NPI:1396010104
Name:ESTRADA, CECILIA KOLSTAD (DMD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:KOLSTAD
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 89TH ST APT 10F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4302
Mailing Address - Country:US
Mailing Address - Phone:954-445-7583
Mailing Address - Fax:
Practice Address - Street 1:200 E 89TH ST APT 10F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4302
Practice Address - Country:US
Practice Address - Phone:954-445-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025492001223P0221X
NY057364-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry