Provider Demographics
NPI:1770778441
Name:GENENE CROFUT DDS, PLLC
Entity type:Organization
Organization Name:GENENE CROFUT DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-688-4501
Mailing Address - Street 1:2715 MILLERSPORT HWY
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1222
Mailing Address - Country:US
Mailing Address - Phone:716-688-4501
Mailing Address - Fax:
Practice Address - Street 1:2715 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1222
Practice Address - Country:US
Practice Address - Phone:716-688-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty