Provider Demographics
NPI:1205028032
Name:CVIRKO, ELLA (DMD)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:CVIRKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33941 FARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-7012
Mailing Address - Country:US
Mailing Address - Phone:251-272-2666
Mailing Address - Fax:
Practice Address - Street 1:33941 FARRINGTON LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-7012
Practice Address - Country:US
Practice Address - Phone:251-272-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist