Provider Demographics
NPI:1417106576
Name:PAGANO, CHRISTOPHER KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KENNETH
Last Name:PAGANO
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 1:407 S PIKE ST
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1125
Mailing Address - Country:US
Mailing Address - Phone:304-592-0600
Mailing Address - Fax:304-592-0642
Practice Address - Street 1:407 S PIKE ST
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1125
Practice Address - Country:US
Practice Address - Phone:304-592-0600
Practice Address - Fax:304-592-0642
Is Sole Proprietor?:No
Enumeration Date:2008-09-14
Last Update Date:2008-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV34031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice