Provider Demographics
NPI:1104910173
Name:DAVIRRO, GARY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:DAVIRRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:680 ALAMO PINTADO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2204
Mailing Address - Country:US
Mailing Address - Phone:805-688-1862
Mailing Address - Fax:805-688-2603
Practice Address - Street 1:680 ALAMO PINTADO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2204
Practice Address - Country:US
Practice Address - Phone:805-688-1862
Practice Address - Fax:805-688-2603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA242841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics