Provider Demographics
NPI:1548838303
Name:CISMAS, JOHN (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CISMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E BROWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4958
Mailing Address - Country:US
Mailing Address - Phone:480-834-6100
Mailing Address - Fax:
Practice Address - Street 1:855 E BROWN RD STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4958
Practice Address - Country:US
Practice Address - Phone:808-346-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2024-11-18
Deactivation Date:2024-11-13
Deactivation Code:
Reactivation Date:2024-11-18
Provider Licenses
StateLicense IDTaxonomies
AZD011061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist