Individual
DR. CRAIG WAYNE TAMONDONG ESTRADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1354 KEMPSVILLE RD, SUITE 101, CHESAPEAKE, VA 23320-1416
(757) 548-1611
(757) 548-1051
Mailing address
1354 KEMPSVILLE RD, SUITE 101, CHESAPEAKE, VA 23320-1416
(757) 548-1611
(757) 548-1051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006969
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
323926
ANTHEM PROVIDER ID
VA
01
—
699529
UNITED CONCORDIA PROVIDER
VA
Enumeration date
01/19/2007
Last updated
07/08/2007
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