Provider Demographics
NPI:1598898793
Name:DIBART, SERGE (DMD DDS)
Entity Type:Individual
Prefix:PROF
First Name:SERGE
Middle Name:
Last Name:DIBART
Suffix:
Gender:M
Credentials:DMD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3968
Mailing Address - Country:US
Mailing Address - Phone:617-926-1013
Mailing Address - Fax:617-926-6739
Practice Address - Street 1:106 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3968
Practice Address - Country:US
Practice Address - Phone:617-926-1013
Practice Address - Fax:617-926-6739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics