Provider Demographics
NPI:1881716793
Name:NIEMINEN-CISNEROS, SAARA KYLLIKKI (DMD)
Entity type:Individual
Prefix:DR
First Name:SAARA
Middle Name:KYLLIKKI
Last Name:NIEMINEN-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 1:319 MAIN ST
Mailing Address - Street 2:STE B-2
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-2063
Mailing Address - Country:US
Mailing Address - Phone:732-495-8600
Mailing Address - Fax:732-495-0907
Practice Address - Street 1:319 MAIN ST
Practice Address - Street 2:STE B-2
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-2063
Practice Address - Country:US
Practice Address - Phone:732-495-8600
Practice Address - Fax:732-495-0907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0178701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice