1922337484 NPI number — DR. MICHAEL PAUL CIMINO D.D.S.

Table of content: DR. MICHAEL PAUL CIMINO D.D.S. (NPI 1922337484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922337484 NPI number — DR. MICHAEL PAUL CIMINO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIMINO
Provider First Name:
MICHAEL
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922337484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3410 LOUISIANA ST
Provider Second Line Business Mailing Address:
3202
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TEXAS
Provider Business Mailing Address Postal Code:
77002
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
504-909-9434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3602 VISTA RD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
711-394-6517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  24594 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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