Provider Demographics
NPI:1437758737
Name:SEBISKO, GIORGI
Entity Type:Individual
Prefix:MR
First Name:GIORGI
Middle Name:
Last Name:SEBISKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34264 CAMINO CAPISTRANO UNIT 307
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1170
Mailing Address - Country:US
Mailing Address - Phone:347-445-2521
Mailing Address - Fax:
Practice Address - Street 1:34264 CAMINO CAPISTRANO UNIT 307
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-1170
Practice Address - Country:US
Practice Address - Phone:347-445-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist