Healthcare Provider Details

I. General information

NPI: 1881716793
Provider Name (Legal Business Name): SAARA KYLLIKKI NIEMINEN-CISNEROS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MAIN ST STE B-2
KEANSBURG NJ
07734-2063
US

IV. Provider business mailing address

319 MAIN ST STE B-2
KEANSBURG NJ
07734-2063
US

V. Phone/Fax

Practice location:
  • Phone: 732-495-8600
  • Fax: 732-495-0907
Mailing address:
  • Phone: 732-495-8600
  • Fax: 732-495-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI017870
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: