Provider Demographics
NPI:1508942830
Name:GENC, ROBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:GENC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE #602
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-640-0300
Mailing Address - Fax:949-640-5412
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:#602
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-640-0300
Practice Address - Fax:949-640-5412
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA421501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice