Provider Demographics
NPI:1144484650
Name:PECOR, CEDRIC CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:CHARLES
Last Name:PECOR
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 1:373 BOVAT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-5412
Mailing Address - Country:US
Mailing Address - Phone:802-999-6245
Mailing Address - Fax:
Practice Address - Street 1:157 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3607
Practice Address - Country:US
Practice Address - Phone:802-893-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600022771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice