Provider Demographics
NPI:1093723223
Name:CISNEROS, JOE MICHAEL SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:MICHAEL
Last Name:CISNEROS
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 TROUSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4561
Mailing Address - Country:US
Mailing Address - Phone:615-831-9010
Mailing Address - Fax:615-831-2808
Practice Address - Street 1:4660 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4561
Practice Address - Country:US
Practice Address - Phone:615-831-9010
Practice Address - Fax:615-831-2808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice