MEDICARE: 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

General Provider Information

NPI Number	:	1952644395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN B. GENNARO D.D.S

Provider Business Mailing 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

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	:	DENTISTIS
Name	:	JOHN B GENNARO
Credential	:	D.D.S.
Telephone Number	:	504-341-5200

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/04/2013

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