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General NPI Number Information
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NPI Number | 1215502968
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Entity Type | Individual
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Provider Name | EVAN ROCCO PAGANO DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 7398 RIVERS AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4613
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Country | US
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Telephone | 843-405-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 S 4TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-1727
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Country | US
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Telephone | 608-320-5530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9923
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License Number State | SC
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