Provider Demographics
NPI:1144221524
Name:GENERSON, RICHARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GENERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WESCOTT DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4600
Mailing Address - Country:US
Mailing Address - Phone:908-788-7475
Mailing Address - Fax:908-788-6604
Practice Address - Street 1:1100 WESCOTT DR
Practice Address - Street 2:SUITE 108
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4600
Practice Address - Country:US
Practice Address - Phone:908-788-7475
Practice Address - Fax:908-788-6604
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ101511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2932008Medicaid
NJ2932008Medicaid
NJT77826Medicare UPIN