Healthcare Provider Details

I. General information

NPI: 1558397224
Provider Name (Legal Business Name): MARY ANN CIMRMANCIC D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W OKLAHOMA AVE
MILWAUKEE WI
53215-4171
US

IV. Provider business mailing address

1587 S MOORLAND RD APT 108
NEW BERLIN WI
53151-1586
US

V. Phone/Fax

Practice location:
  • Phone: 414-389-1984
  • Fax:
Mailing address:
  • Phone: 414-520-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3330-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: