Provider Demographics
NPI:1710107487
Name:PAXTON, LUCIA (DDS)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 RESEDA BLVD
Mailing Address - Street 2:STE. 2
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2608
Mailing Address - Country:US
Mailing Address - Phone:818-996-5355
Mailing Address - Fax:818-996-4072
Practice Address - Street 1:5550 RESEDA BLVD
Practice Address - Street 2:STE. 2
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2608
Practice Address - Country:US
Practice Address - Phone:818-996-5355
Practice Address - Fax:818-996-4072
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist