Healthcare Provider Details

I. General information

NPI: 1003974932
Provider Name (Legal Business Name): ROBERT ANDREW CISNEROS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 S PANAM EXPY STE 1
SAN ANTONIO TX
78225-2301
US

IV. Provider business mailing address

4407 S PAN AM SUITE 1
SAN ANTONIO TX
78225
US

V. Phone/Fax

Practice location:
  • Phone: 210-533-6603
  • Fax: 210-533-6605
Mailing address:
  • Phone: 210-533-6603
  • Fax: 210-533-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: