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General NPI Number Information
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NPI Number | 1053573790
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Entity Type | Individual
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Provider Name | TERESA S GENESER DMD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 2218 1ST AVE NE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-6347
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Country | US
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Telephone | 319-364-2413
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Fax | 319-364-8179
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Provider Business Mailing Address
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Address Line | 1962 1ST AVE NE CEDAR RAPIDS PEDIATRIC DENTISTRY
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-5330
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Country | US
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Telephone | 319-364-2413
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Fax | 319-364-8179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 08795
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | LD00035
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30288
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License Number State | IA
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