Provider Demographics
NPI:1154550028
Name:GENHO, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GENHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 YELLOWTAIL RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-6102
Mailing Address - Country:US
Mailing Address - Phone:307-635-9251
Mailing Address - Fax:307-635-9218
Practice Address - Street 1:6900 YELLOWTAIL RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-6102
Practice Address - Country:US
Practice Address - Phone:307-635-9251
Practice Address - Fax:307-635-9218
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist