Provider Demographics
NPI:1356346340
Name:CISNEROS, AURA MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:AURA
Middle Name:MARIA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:2814 14TH AVE SE
Practice Address - Street 2:RUSKIN HEALTH CENTER
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-349-7834
Practice Address - Fax:813-349-7861
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24861223G0001X
FLDN193151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9790040OtherINS. CO. HUMANA
PR043023OtherINS. CO. CRUZ AZUL
PR42473OtherINSURANCE COMPANY SSS
PR206476OtherINS. CO. UTI