Healthcare Provider Details

I. General information

NPI: 1376462424
Provider Name (Legal Business Name): YISELY NEVARES CINTRA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W 13 MILE RD STE 100
MADISON HEIGHTS MI
48071-1868
US

IV. Provider business mailing address

1634 OSPREY LN
LUTZ FL
33549-4116
US

V. Phone/Fax

Practice location:
  • Phone: 248-583-9888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: