Provider Demographics
NPI:1558751156
Name:XAVIER, DENISE (RDH, RDHAP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:XAVIER
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 1/2 RIVERSIDE DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2561
Mailing Address - Country:US
Mailing Address - Phone:401-413-7931
Mailing Address - Fax:
Practice Address - Street 1:5125 STROHM AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4154
Practice Address - Country:US
Practice Address - Phone:401-413-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551124Q00000X
CA25014124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist