Healthcare Provider Details

I. General information

NPI: 1205703683
Provider Name (Legal Business Name): RICARDO ANTONIO CISNEROS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13146 MEMORIAL DR
HOUSTON TX
77079-7200
US

IV. Provider business mailing address

1901 POST OAK BLVD APT 3405
HOUSTON TX
77056-3940
US

V. Phone/Fax

Practice location:
  • Phone: 713-468-7222
  • Fax:
Mailing address:
  • Phone: 832-722-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number42002
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: