Provider Demographics
NPI:1295790079
Name:SAM J CITRANO JR DMD PC
Entity type:Organization
Organization Name:SAM J CITRANO JR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CITRANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-534-7692
Mailing Address - Street 1:411 HOLMES AVE NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4142
Mailing Address - Country:US
Mailing Address - Phone:256-534-7692
Mailing Address - Fax:256-534-7692
Practice Address - Street 1:411 HOLMES AVE NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4142
Practice Address - Country:US
Practice Address - Phone:256-534-7692
Practice Address - Fax:256-534-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty