Healthcare Provider Details

I. General information

NPI: 1356346340
Provider Name (Legal Business Name): AURA MARIA CISNEROS D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 14TH AVE SE RUSKIN HEALTH CENTER
RUSKIN FL
33570
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-349-7834
  • Fax: 813-349-7861
Mailing address:
  • Phone: 813-349-7568
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2486
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN19315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: