Provider Demographics
NPI:1437223179
Name:MICHAEL CITO DDS LLC
Entity Type:Organization
Organization Name:MICHAEL CITO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-298-5522
Mailing Address - Street 1:3900 EUBANK NE
Mailing Address - Street 2:STE 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-298-5522
Mailing Address - Fax:505-291-0653
Practice Address - Street 1:3900 EUBANK NE
Practice Address - Street 2:STE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-298-5522
Practice Address - Fax:505-291-0653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL CITO DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD11941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000080432Medicaid
0003121OtherDORAL DENTAL
NM95608001Medicaid
467569OtherUNITED CONCORDIA
NM50603736Medicaid