Provider Demographics
NPI:1942346093
Name:GENASCI, PAUL ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:GENASCI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 LAKE TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7805
Mailing Address - Country:US
Mailing Address - Phone:530-544-4893
Mailing Address - Fax:530-544-1381
Practice Address - Street 1:2867 LAKE TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7805
Practice Address - Country:US
Practice Address - Phone:530-544-4893
Practice Address - Fax:530-544-1381
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice