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NPI Code Detail

MEDICARE: EDWARD GENECOV DDS INC

MEDICARE: EDWARD GENECOV DDS INC
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
1174400000XSpecialist6196TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11346366705OTHERTXNPI

General Provider Information

NPI Number : 1255590055
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDWARD GENECOV DDS INC
Provider Business Mailing Address
First Line : 5410 ALPHA RD
Second Line :
City : DALLAS
State : TX
Zip : 75240-4506
Country : US
Telephone Number : 972-387-9770
Fax Number : 972-387-0551
Provider Business Practice Location Address
First Line : 5410 ALPHA RD
Second Line :
City : DALLAS
State : TX
Zip : 75240-4506
Country : US
Telephone Number : 972-387-9770
Fax Number : 972-387-0551
Authorized Official
Title or Position : DOCTOR
Name : DR. JEFFREY GENECOV
Credential : DDS
Telephone Number : 972-387-9770
Provider Enumeration Date : 06/06/2008
Last Update Date : 06/06/2008

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