Provider Demographics
NPI:1659413227
Name:FERRARO, PAUL KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:FERRARO
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 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE #308
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6409
Mailing Address - Country:US
Mailing Address - Phone:949-364-6110
Mailing Address - Fax:
Practice Address - Street 1:8327 DAVIS ST
Practice Address - Street 2:SUITE #100
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4998
Practice Address - Country:US
Practice Address - Phone:562-869-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice