Provider Demographics
NPI:1871949107
Name:ESTRELLA, ALICIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:ESTRELLA
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 1:7490 BROMPTON ST APT 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2292
Mailing Address - Country:US
Mailing Address - Phone:562-335-8508
Mailing Address - Fax:
Practice Address - Street 1:406 SCIENCE DR STE 402
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1068
Practice Address - Country:US
Practice Address - Phone:608-231-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001282-151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics