Provider Demographics
NPI:1720724321
Name:OCHOA, DAVID JAVIER (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAVIER
Last Name:OCHOA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32001 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2002
Mailing Address - Country:US
Mailing Address - Phone:909-549-8702
Mailing Address - Fax:
Practice Address - Street 1:7733 E JEFFERSON AVE STE 70
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3707
Practice Address - Country:US
Practice Address - Phone:313-499-4775
Practice Address - Fax:313-499-4952
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601272122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program