Healthcare Provider Details

I. General information

NPI: 1720724321
Provider Name (Legal Business Name): DAVID JAVIER OCHOA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 E JEFFERSON AVE STE 70
DETROIT MI
48214-3707
US

IV. Provider business mailing address

32001 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-2002
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax: 313-499-4952
Mailing address:
  • Phone: 909-549-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601272
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: