Provider Demographics
NPI:1760685796
Name:PIROK, DARRYL JOHN (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:JOHN
Last Name:PIROK
Suffix:
Gender:M
Credentials:DDS MS
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 608
Mailing Address - Street 2:
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175
Mailing Address - Country:US
Mailing Address - Phone:804-758-4870
Mailing Address - Fax:804-758-4873
Practice Address - Street 1:247 GLOUCESTER ROAD
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:VA
Practice Address - Zip Code:23149
Practice Address - Country:US
Practice Address - Phone:804-758-4870
Practice Address - Fax:804-758-4873
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005020122300000X
VA04380001251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA112371OtherUNITED CONCORDIA
VA197930508Medicare ID - Type Unspecified
VA112371OtherUNITED CONCORDIA