Provider Demographics
NPI:1770011942
Name:GAXIOLA, CARLOS E (RDH)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:E
Last Name:GAXIOLA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 S 4TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8101
Mailing Address - Country:US
Mailing Address - Phone:928-726-6023
Mailing Address - Fax:
Practice Address - Street 1:2816 S 4TH AVE STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8101
Practice Address - Country:US
Practice Address - Phone:928-726-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH007841124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist