Provider Demographics
NPI:1568683902
Name:CROFUT, GENENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENENE
Middle Name:
Last Name:CROFUT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 MILLERSPORT HWY
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1222
Mailing Address - Country:US
Mailing Address - Phone:716-688-4501
Mailing Address - Fax:716-688-4587
Practice Address - Street 1:2715 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1222
Practice Address - Country:US
Practice Address - Phone:716-688-4501
Practice Address - Fax:716-688-4587
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice