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General NPI Number Information
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NPI Number | 1912563958
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Entity Type | Organization
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Legal Business Name | CISNEROS DENTISTRY PLLC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 918 W SOUTHMORE AVE STE 115
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City | PASADENA
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State | TX
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Zip | 77502-1020
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Country | US
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Telephone | 832-489-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 918 W SOUTHMORE AVE STE 115
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City | PASADENA
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State | TX
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Zip | 77502-1020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARMEN MARMOL
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Credential |
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Telephone | 832-489-2881
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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 |
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License Number State |
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