Provider Demographics
NPI:1982931556
Name:CISNEROS DENTISTRY
Entity type:Organization
Organization Name:CISNEROS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-450-2900
Mailing Address - Street 1:1313 HOLLAND ST STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-2873
Mailing Address - Country:US
Mailing Address - Phone:713-450-2900
Mailing Address - Fax:713-453-2479
Practice Address - Street 1:1313 HOLLAND ST STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2873
Practice Address - Country:US
Practice Address - Phone:713-450-2900
Practice Address - Fax:713-453-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173700903Medicaid