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General NPI Number Information
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NPI Number | 1558397224
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Entity Type | Individual
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Provider Name | MARY ANN CIMRMANCIC D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3535 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-4171
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Country | US
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Telephone | 414-389-1984
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Fax |
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Provider Business Mailing Address
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Address Line | 1587 S MOORLAND RD APT 108
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City | NEW BERLIN
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State | WI
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Zip | 53151-1586
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Country | US
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Telephone | 414-520-1884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3330-015
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License Number State | WI
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