Healthcare Provider Details

I. General information

NPI: 1528104825
Provider Name (Legal Business Name): GEORGE J. CISNEROS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 BRONXDALE AVE
BRONX NY
10462-3388
US

IV. Provider business mailing address

4528 BOSTON POST RD
PELHAM NY
10803-2801
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-7972
  • Fax:
Mailing address:
  • Phone: 914-738-8141
  • Fax: 212-995-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number037341
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number037341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: