Healthcare Provider Details

I. General information

NPI: 1437223179
Provider Name (Legal Business Name): MICHAEL CITO DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 EUBANK NE STE 2
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

3900 EUBANK NE STE 2
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-5522
  • Fax: 505-291-0653
Mailing address:
  • Phone: 505-298-5522
  • Fax: 505-291-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDD1194
License Number StateNM

VIII. Authorized Official

Name: DR. STEPHEN MICHAEL CITO JR.
Title or Position: OWNER/OPERATOR
Credential: DDS
Phone: 505-298-5522