Provider Demographics
NPI:1851941249
Name:GENUNG, PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GENUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:F
Other - Last Name:GENUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1904 3RD AVE STE 1031
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1199
Mailing Address - Country:US
Mailing Address - Phone:206-623-4674
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 1031
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1199
Practice Address - Country:US
Practice Address - Phone:206-623-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00003370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist