MEDICARE: DR. JOHN B GENNARO D.D.S

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
1	1223G0001X	General Practice Dentistry	2285	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316073786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B GENNARO D.D.S

Provider Business Mailing Address
First Line	:	4917 GUIDRY ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-1120
Country	:	US
Telephone Number	:	504-779-6360
Fax Number	:	504-341-6977

Provider Business Practice Location Address
First Line	:	828 AVENUE G
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-1830
Country	:	US
Telephone Number	:	504-341-5200
Fax Number	:	504-341-6977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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