Provider Demographics
NPI:1558397224
Name:CIMRMANCIC, MARY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:CIMRMANCIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 S MOORLAND RD APT 108
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1586
Mailing Address - Country:US
Mailing Address - Phone:414-520-1884
Mailing Address - Fax:
Practice Address - Street 1:3535 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4171
Practice Address - Country:US
Practice Address - Phone:414-389-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3330-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice