MEDICARE: ELLA CVIRKO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5743	AL

General Provider Information

NPI Number	:	1205028032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA CVIRKO DMD

Provider Business Mailing Address
First Line	:	33941 FARRINGTON LN
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-7012
Country	:	US
Telephone Number	:	251-272-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	33941 FARRINGTON LN
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-7012
Country	:	US
Telephone Number	:	251-272-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/16/2015

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