Provider Demographics
NPI:1194792911
Name:CIMINO, VICTOR (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:CIMINO
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4267
Mailing Address - Country:US
Mailing Address - Phone:847-268-3910
Mailing Address - Fax:847-897-3118
Practice Address - Street 1:22 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4267
Practice Address - Country:US
Practice Address - Phone:847-268-3910
Practice Address - Fax:708-327-3463
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210023741223S0112X
IL360911952086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery