Healthcare Provider Details

I. General information

NPI: 1548249667
Provider Name (Legal Business Name): CECILIA CATHERINE PAIRO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 535
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 535
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 390818116008
  • Fax: 390818116496
Mailing address:
  • Phone: 390818116008
  • Fax: 390818116496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4982
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: