Provider Demographics
NPI:1205854189
Name:GENET, BERNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:GENET
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 1:611 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2325
Mailing Address - Country:US
Mailing Address - Phone:856-783-8600
Mailing Address - Fax:
Practice Address - Street 1:611 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2325
Practice Address - Country:US
Practice Address - Phone:856-783-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist