Provider Demographics
NPI:1194398032
Name:CISNEROS, MARIA CRISTINA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MARIA CRISTINA
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34766 CAPROCK RD
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5422
Mailing Address - Country:US
Mailing Address - Phone:661-607-1512
Mailing Address - Fax:
Practice Address - Street 1:43531 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6005
Practice Address - Country:US
Practice Address - Phone:661-839-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist