Provider Demographics
NPI:1841608981
Name:PHILIP J CIMO DDS PA
Entity Type:Organization
Organization Name:PHILIP J CIMO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-464-1887
Mailing Address - Street 1:650 W BOUGH LN STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4099
Mailing Address - Country:US
Mailing Address - Phone:713-464-1887
Mailing Address - Fax:
Practice Address - Street 1:650 W BOUGH LN STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4099
Practice Address - Country:US
Practice Address - Phone:713-464-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty