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General NPI Number Information
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NPI Number | 1609695014
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Entity Type | Organization
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Legal Business Name | GENASCI AND STIGERS DENTAL CORPORATION
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2867 LAKE TAHOE BLVD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7805
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Country | US
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Telephone | 530-544-4893
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Fax |
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Provider Business Mailing Address
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Address Line | 19601 N BLACK CANYON HWY # 201
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City | PHOENIX
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State | AZ
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Zip | 85027-4107
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Country | US
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Telephone | 623-289-3392
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MERCEDES FIGUEROA
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Credential |
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Telephone | 623-289-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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