Provider Demographics
NPI:1043498728
Name:ESTRADA, RONALD PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PHILIP
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 1:1477 SAN MARINO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2052
Mailing Address - Country:US
Mailing Address - Phone:626-793-6662
Mailing Address - Fax:626-793-0939
Practice Address - Street 1:1477 SAN MARINO AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2052
Practice Address - Country:US
Practice Address - Phone:626-793-6662
Practice Address - Fax:626-793-0939
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice