Provider Demographics
NPI:1760508469
Name:GENUALDI, ANDREW G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:GENUALDI
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 1:575 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4503
Mailing Address - Country:US
Mailing Address - Phone:908-273-5242
Mailing Address - Fax:
Practice Address - Street 1:575 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4503
Practice Address - Country:US
Practice Address - Phone:908-273-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ99241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice