Provider Demographics
NPI:1902024631
Name:CIBOROWSKI, CASIMER JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:CASIMER
Middle Name:JAMES
Last Name:CIBOROWSKI
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 1:17299 OHARA DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2283
Mailing Address - Country:US
Mailing Address - Phone:941-255-5318
Mailing Address - Fax:
Practice Address - Street 1:941 TAMIAMI TRL
Practice Address - Street 2:SUITE F
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3121
Practice Address - Country:US
Practice Address - Phone:941-629-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00126651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice