Provider Demographics
NPI:1528352127
Name:LORA GAXIOLA DMD INC.
Entity type:Organization
Organization Name:LORA GAXIOLA DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAXIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-981-2994
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty