Provider Demographics
NPI:1326159757
Name:GOGILTAN-WAXLER, ELENA LUCIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:LUCIA
Last Name:GOGILTAN-WAXLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:2410 SYCAMORE DR
Practice Address - Street 2:STE A
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2350
Practice Address - Country:US
Practice Address - Phone:805-522-2600
Practice Address - Fax:805-522-2683
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA470801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice