Provider Demographics
NPI:1346520616
Name:JAMES E. GENOBAGA, DDS, INC.
Entity Type:Organization
Organization Name:JAMES E. GENOBAGA, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GENOBAGA
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-763-4231
Mailing Address - Street 1:367 DEL NORTE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4116
Mailing Address - Country:US
Mailing Address - Phone:530-763-4231
Mailing Address - Fax:530-763-4316
Practice Address - Street 1:367 DEL NORTE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4116
Practice Address - Country:US
Practice Address - Phone:530-763-4231
Practice Address - Fax:530-763-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146333Medicaid