Healthcare Provider Details

I. General information

NPI: 1124982954
Provider Name (Legal Business Name): DANISE JOSHUA RIVERA CANDELOZA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W AVENUE K STE 105
LANCASTER CA
93534-6429
US

IV. Provider business mailing address

1025 W AVENUE K STE 105
LANCASTER CA
93534-6429
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: