MEDICARE: JAMES EARL GENOBAGA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4387	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285687715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EARL GENOBAGA DDS

Provider Business Mailing Address
First Line	:	367 DEL NORTE AVE
Second Line	:	SUITE 1
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4116
Country	:	US
Telephone Number	:	530-763-4231
Fax Number	:	530-763-4316

Provider Business Practice Location Address
First Line	:	367 DEL NORTE AVE
Second Line	:	SUITE 1
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4116
Country	:	US
Telephone Number	:	530-763-4231
Fax Number	:	530-763-4316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/20/2011

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