MEDICARE: DR. GENEVIEVE PRISCILLA POITRAS DDS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1841976610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENEVIEVE PRISCILLA POITRAS DDS

Provider Business Mailing Address
First Line	:	2133 PEPPERELL STREET-BUILDING 3352
Second Line	:	JBSA LACKLAND
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	207-753-9094
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 PEPPERELL STREET-BUILDING 3352
Second Line	:	JBSA LACKLAND
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	210-292-6258
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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