Craig Wayne Tamondong Estrada, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401006969 Issued in VA

Practice address

1354 Kempsville Rd
Suite 101
Chesapeake, VA 23320-1416

Phone

(757) 548-1611

Fax

(757) 548-1051

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Estrada & Estrada, PC

  • Dentist
  • Chesapeake, VA
  • NPI 1093074189
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497808737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1354 KEMPSVILLE RD",
            "address_2": "SUITE 101",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201416",
            "telephone_number": "757-548-1611",
            "fax_number": "757-548-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1354 KEMPSVILLE RD",
            "address_2": "SUITE 101",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201416",
            "telephone_number": "757-548-1611",
            "fax_number": "757-548-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRADA",
        "first_name": "CRAIG",
        "middle_name": "WAYNE TAMONDONG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401006969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "699529",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER ID",
            "identifier": "323926",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Essential Mobile Services
• Jacob Louis Estienne, MS, OTR/L
• Estrada & Estrada, PC
• Estrada & Estrada, PC
• Charito Mangaya Estrada, DDS
• Melissa Tan Estrada, APRN
• Daniel M Etheridge, DDS
• Anne Kristine Moore Etherton, RD
• Matthew Eubanks
• Stella Virginia Eubanks, LPC LSATP LMFT

• General Practice Dentistry in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.