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General NPI Number Information
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NPI Number | 1376833855
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Entity Type | Organization
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Legal Business Name | GENCO DENTAL CARE, PC
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 518 MAIN ST
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City | FOREST CITY
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State | PA
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Zip | 18421-1498
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Country | US
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Telephone | 570-785-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 518 MAIN ST
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City | FOREST CITY
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State | PA
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Zip | 18421-1498
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Country | US
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Telephone | 570-785-9500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERARD T GENCO
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Credential | D.M.D.
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Telephone | 570-785-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS030379L
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License Number State | PA
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