Provider Demographics
NPI:1912079229
Name:CIMO, PHILIP JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:CIMO
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 1:650 WEST BOUGH LANE
Mailing Address - Street 2:STE #160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-464-1887
Mailing Address - Fax:713-827-0985
Practice Address - Street 1:650 WEST BOUGH LANE
Practice Address - Street 2:STE #160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-464-1887
Practice Address - Fax:713-827-0985
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20357122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist