Provider Demographics
NPI:1508912445
Name:GENI, MARILYN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:R
Last Name:GENI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:GENI
Other - Last Name:BLANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1511
Mailing Address - Country:US
Mailing Address - Phone:203-222-1316
Mailing Address - Fax:
Practice Address - Street 1:15 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4302
Practice Address - Country:US
Practice Address - Phone:203-227-2520
Practice Address - Fax:203-454-8710
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice