Provider Demographics
NPI:1962626853
Name:CISNEROS, VICTORIA QUITENO (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:QUITENO
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 HOLLAND ST STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-2873
Mailing Address - Country:US
Mailing Address - Phone:713-450-2900
Mailing Address - Fax:713-453-2479
Practice Address - Street 1:1313 HOLLAND ST STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2873
Practice Address - Country:US
Practice Address - Phone:713-450-2900
Practice Address - Fax:713-453-2479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221481223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty