Provider Demographics
NPI:1902001811
Name:CISTERNAS, STEVEN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:CISTERNAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5905
Mailing Address - Country:US
Mailing Address - Phone:718-698-3384
Mailing Address - Fax:718-989-6989
Practice Address - Street 1:211 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5905
Practice Address - Country:US
Practice Address - Phone:718-698-3384
Practice Address - Fax:718-989-6989
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist