Healthcare Provider Details

I. General information

NPI: 1205562725
Provider Name (Legal Business Name): ANDREA PAOLA CIURO SONE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 ENDURING FREEDOM DR
FORT DRUM NY
13602-5503
US

IV. Provider business mailing address

10590 ENDURING FREEDOM DR
FORT DRUM NY
13602-5503
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-5576
  • Fax:
Mailing address:
  • Phone: 315-772-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12914055-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: