Provider Demographics
NPI:1578230728
Name:CISMARESCU, SERBAN GABRIEL (DMD)
Entity Type:Individual
Prefix:
First Name:SERBAN
Middle Name:GABRIEL
Last Name:CISMARESCU
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 1:4804 S COLLEGE RD UNIT 28
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2237
Mailing Address - Country:US
Mailing Address - Phone:516-532-3107
Mailing Address - Fax:
Practice Address - Street 1:6132 CAROLINA BEACH RD STE 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2759
Practice Address - Country:US
Practice Address - Phone:910-392-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice