Provider Demographics
NPI:1003800046
Name:CITRANO, SAM J JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:J
Last Name:CITRANO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HOLMES AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4142
Mailing Address - Country:US
Mailing Address - Phone:256-534-7692
Mailing Address - Fax:256-534-7692
Practice Address - Street 1:411 HOLMES AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4142
Practice Address - Country:US
Practice Address - Phone:256-534-7692
Practice Address - Fax:256-534-7692
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice