MEDICARE: DR. KERRY C. DAVIRRO D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		CA

General Provider Information

NPI Number	:	1952482259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY C. DAVIRRO D.D.S.

Provider Business Mailing Address
First Line	:	881 ALMA REAL DR
Second Line	:	SUITE 105
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-459-9833
Fax Number	:	310-459-9834

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR
Second Line	:	SUITE 105
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-459-9833
Fax Number	:	310-459-9834

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. KERRY C. DAVIRRO D.D.S.” Practice Location

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