Provider Demographics
NPI:1518214782
Name:GENNAOUI, DANNY (DMD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:GENNAOUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S LINDBERGH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1372
Mailing Address - Country:US
Mailing Address - Phone:314-821-4410
Mailing Address - Fax:
Practice Address - Street 1:3701 S LINDBERGH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1372
Practice Address - Country:US
Practice Address - Phone:314-821-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120199021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice