Provider Demographics
NPI:1427669613
Name:LUZ E ESTRADA DDS PLLC III
Entity type:Organization
Organization Name:LUZ E ESTRADA DDS PLLC III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER MADS
Authorized Official - Prefix:
Authorized Official - First Name:SONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-844-2281
Mailing Address - Street 1:933 ROCKFORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5323
Mailing Address - Country:US
Mailing Address - Phone:336-844-2281
Mailing Address - Fax:
Practice Address - Street 1:933 ROCKFORD ST STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5323
Practice Address - Country:US
Practice Address - Phone:336-844-2281
Practice Address - Fax:336-750-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty