Healthcare Provider Details

I. General information

NPI: 1477613636
Provider Name (Legal Business Name): CYNTHIA RACHEL VARRO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 S PACIFIC HIGHWAY
MEDFORD OR
97501
US

IV. Provider business mailing address

1701 NW HAWTHORNE AVENUE
GRANTS PASS OR
97526
US

V. Phone/Fax

Practice location:
  • Phone: 541-512-3182
  • Fax: 541-512-1026
Mailing address:
  • Phone: 541-479-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD8255
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: