Healthcare Provider Details

I. General information

NPI: 1982931556
Provider Name (Legal Business Name): CISNEROS DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 HOLLAND ST STE E
HOUSTON TX
77029-2873
US

IV. Provider business mailing address

1313 HOLLAND ST STE E
HOUSTON TX
77029-2873
US

V. Phone/Fax

Practice location:
  • Phone: 713-450-2900
  • Fax: 713-453-2479
Mailing address:
  • Phone: 713-450-2900
  • Fax: 713-453-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22148
License Number StateTX

VIII. Authorized Official

Name: VICTORIA Q. CISNEROS
Title or Position: OWNER
Credential:
Phone: 713-450-2900