Provider Demographics
NPI:1962745794
Name:ESTRADA, LUZ DEL CARMEN
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:DEL CARMEN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:DEL CARMEN
Other - Last Name:BURCIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1803 TOMAHAWK RD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-3200
Mailing Address - Country:US
Mailing Address - Phone:316-807-0554
Mailing Address - Fax:
Practice Address - Street 1:2300 N 14TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2367
Practice Address - Country:US
Practice Address - Phone:620-225-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2737124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist