Provider Demographics
NPI:1376791897
Name:GAXIOLA, LORA PACHA (DMD)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:PACHA
Last Name:GAXIOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 NARROWS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8667
Mailing Address - Country:US
Mailing Address - Phone:205-981-2994
Mailing Address - Fax:205-981-2961
Practice Address - Street 1:194 NARROWS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8667
Practice Address - Country:US
Practice Address - Phone:205-981-2994
Practice Address - Fax:205-981-2961
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice