Provider Demographics
NPI:1215502968
Name:PAGANO, EVAN ROCCO (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROCCO
Last Name:PAGANO
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 1:1016 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1727
Mailing Address - Country:US
Mailing Address - Phone:608-320-5530
Mailing Address - Fax:
Practice Address - Street 1:7398 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4613
Practice Address - Country:US
Practice Address - Phone:843-405-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist