Organization
DANIEL T. ESTACIO, DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL TORIBIO ESTACIO DDS (DENTIST/PRESIDENT)
(818) 247-3387
Entity
Organization
Contact information
Practice address
1140 E CHEVY CHASE DR, GLENDALE, CA 91205-2511
(818) 247-3387
(818) 247-2680
Mailing address
1140 E CHEVY CHASE DR, GLENDALE, CA 91205-2511
(818) 247-3387
(818) 247-2680
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
47886
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G-93853-01
MEDI-CAL PROVIDER NO
CA
Enumeration date
09/27/2007
Last updated
09/27/2007
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