Provider Demographics
NPI:1376833855
Name:GENCO DENTAL CARE, PC
Entity Type:Organization
Organization Name:GENCO DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:GENCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-785-9500
Mailing Address - Street 1:518 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1498
Mailing Address - Country:US
Mailing Address - Phone:570-785-9500
Mailing Address - Fax:
Practice Address - Street 1:518 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1498
Practice Address - Country:US
Practice Address - Phone:570-785-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030379L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty