Provider Demographics
NPI:1154472520
Name:GENNARO, PATRICIA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:GENNARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 MEDINAH CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-3124
Mailing Address - Country:US
Mailing Address - Phone:708-396-2469
Mailing Address - Fax:
Practice Address - Street 1:6941 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2330
Practice Address - Country:US
Practice Address - Phone:773-586-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice