Provider Demographics
NPI:1528104825
Name:CISNEROS, GEORGE J (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:CISNEROS
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 1:4528 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2801
Mailing Address - Country:US
Mailing Address - Phone:914-738-8141
Mailing Address - Fax:212-995-4852
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-792-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0373411223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics