Basic Information
| Provider Information | |||||||||
| NPI: | 1003800046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CITRANO | ||||||||
| FirstName: | SAM | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 HOLMES AVE NE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565347692 | ||||||||
| FaxNumber: | 2565347692 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 HOLMES AVE NE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565347692 | ||||||||
| FaxNumber: | 2565347692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 4772 | AL | Y | Dental Providers | Dentist | General Practice |
No ID Information.