Provider Demographics
NPI:1487098232
Name:IRELAN, ESTELLA A (DDS, MDS)
Entity type:Individual
Prefix:
First Name:ESTELLA
Middle Name:A
Last Name:IRELAN
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:A
Other - Last Name:PIZANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9556 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8226
Mailing Address - Country:US
Mailing Address - Phone:231-613-5069
Mailing Address - Fax:
Practice Address - Street 1:819 NEEDHAM DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-9403
Practice Address - Country:US
Practice Address - Phone:615-455-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000010892122300000X, 1223E0200X
WI7126-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice