Provider Demographics
NPI:1780725697
Name:CIMINIERI, JASON R (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:CIMINIERI
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 1:11111 NALL AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1625
Mailing Address - Country:US
Mailing Address - Phone:913-491-4900
Mailing Address - Fax:913-491-4996
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1620
Practice Address - Country:US
Practice Address - Phone:913-491-4900
Practice Address - Fax:913-491-4996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist