Provider Demographics
NPI:1487216016
Name:GENELLO, MARIA KATHRYN (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KATHRYN
Last Name:GENELLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1147
Mailing Address - Country:US
Mailing Address - Phone:570-489-2101
Mailing Address - Fax:
Practice Address - Street 1:400 DUNMORE ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1147
Practice Address - Country:US
Practice Address - Phone:570-489-2101
Practice Address - Fax:570-489-7227
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0422841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice