Provider Demographics
NPI:1629846753
Name:CIRILLO, ISAURA CONCEPCION (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISAURA
Middle Name:CONCEPCION
Last Name:CIRILLO
Suffix:
Gender:F
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:PO BOX 5868
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-5868
Mailing Address - Country:US
Mailing Address - Phone:970-468-5995
Mailing Address - Fax:
Practice Address - Street 1:115 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-6034
Practice Address - Country:US
Practice Address - Phone:970-469-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002058281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice