Provider Demographics
NPI:1336213156
Name:GENERALOVICH, BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:GENERALOVICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 SHENANGO VALLEY FREEWAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2544
Mailing Address - Country:US
Mailing Address - Phone:724-981-3422
Mailing Address - Fax:724-981-3526
Practice Address - Street 1:2213 SHENANGO VALLEY FREEWAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2544
Practice Address - Country:US
Practice Address - Phone:724-981-3422
Practice Address - Fax:724-981-3526
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016694L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist