Provider Demographics
NPI:1821211178
Name:MCGIVERN, ROSA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:MARIE
Last Name:MCGIVERN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:MARIE
Other - Last Name:ORDONEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6208 NORMANDY TER
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5818
Mailing Address - Country:US
Mailing Address - Phone:805-427-5913
Mailing Address - Fax:
Practice Address - Street 1:1240 S WESTLAKE BLVD STE 225
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1998
Practice Address - Country:US
Practice Address - Phone:805-496-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist