Provider Demographics
NPI:1942496658
Name:JOSE R GENO DMD PA
Entity Type:Organization
Organization Name:JOSE R GENO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GENO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-854-8707
Mailing Address - Street 1:2200 SW 16TH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-854-8707
Mailing Address - Fax:305-854-8720
Practice Address - Street 1:2200 SW 16TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-854-8707
Practice Address - Fax:305-854-8720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE R GENO DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty