Provider Demographics
NPI:1952482259
Name:DAVIRRO, KERRY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:DAVIRRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:881 ALMA REAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3731
Mailing Address - Country:US
Mailing Address - Phone:310-459-9833
Mailing Address - Fax:310-459-9834
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:310-459-9833
Practice Address - Fax:310-459-9834
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics