Provider Demographics
NPI:1407614894
Name:OCHOA ESTRADA, CAROLINA (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:OCHOA 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 1:2492 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2560
Mailing Address - Country:US
Mailing Address - Phone:561-410-8114
Mailing Address - Fax:
Practice Address - Street 1:2492 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2560
Practice Address - Country:US
Practice Address - Phone:614-108-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN29643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program