Provider Demographics
NPI:1407110992
Name:PAPA, CEDRIC (DDS)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:PAPA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-1806
Mailing Address - Country:US
Mailing Address - Phone:573-594-6166
Mailing Address - Fax:
Practice Address - Street 1:2211 HOLLOW RIDGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9854
Practice Address - Country:US
Practice Address - Phone:415-413-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120212201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice