Provider Demographics
NPI:1336593888
Name:GENTOX LAB SERVICES LLC
Entity type:Organization
Organization Name:GENTOX LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-891-5015
Mailing Address - Street 1:4372 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3701
Mailing Address - Country:US
Mailing Address - Phone:972-891-5015
Mailing Address - Fax:
Practice Address - Street 1:4372 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3701
Practice Address - Country:US
Practice Address - Phone:972-891-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2062168291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory