Provider Demographics
NPI:1124108899
Name:GENECOV, JEFFREY S (DDS, MSD, FACD, FICD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:GENECOV
Suffix:
Gender:M
Credentials:DDS, MSD, FACD, FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 W PARKER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7732
Mailing Address - Country:US
Mailing Address - Phone:972-378-6998
Mailing Address - Fax:972-378-6961
Practice Address - Street 1:5926 W PARKER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7732
Practice Address - Country:US
Practice Address - Phone:972-378-6998
Practice Address - Fax:972-378-6961
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics