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General NPI Number Information
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NPI Number | 1255590055
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Entity Type | Organization
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Legal Business Name | EDWARD GENECOV DDS INC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 5410 ALPHA RD
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City | DALLAS
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State | TX
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Zip | 75240-4506
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Country | US
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Telephone | 972-387-9770
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Fax | 972-387-0551
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Provider Business Mailing Address
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Address Line | 5410 ALPHA RD
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City | DALLAS
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State | TX
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Zip | 75240-4506
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Country | US
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Telephone | 972-387-9770
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Fax | 972-387-0551
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JEFFREY GENECOV
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Credential | DDS
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Telephone | 972-387-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6196
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License Number State | TX
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