Provider Demographics
NPI:1023029022
Name:SHVARTS, GENRICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENRICH
Middle Name:
Last Name:SHVARTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 E 19TH ST
Mailing Address - Street 2:APT. 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5457
Mailing Address - Country:US
Mailing Address - Phone:917-291-0416
Mailing Address - Fax:
Practice Address - Street 1:2071 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4101
Practice Address - Country:US
Practice Address - Phone:212-410-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDORAL12105Other12105
NY01783706Medicaid