Provider Demographics
NPI:1922337484
Name:CIMINO, MICHAEL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:CIMINO
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 1:3410 LOUISIANA ST
Mailing Address - Street 2:3202
Mailing Address - City:HOUSTON
Mailing Address - State:TEXAS
Mailing Address - Zip Code:77002
Mailing Address - Country:UM
Mailing Address - Phone:504-909-9434
Mailing Address - Fax:
Practice Address - Street 1:3602 VISTA RD
Practice Address - Street 2:SUITE H
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1942
Practice Address - Country:US
Practice Address - Phone:711-394-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2009-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice