Provider Demographics
NPI:1588864714
Name:GENET, DAVID GARY (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GARY
Last Name:GENET
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 1:19080 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2805
Mailing Address - Country:US
Mailing Address - Phone:305-933-8700
Mailing Address - Fax:305-933-4051
Practice Address - Street 1:19080 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2805
Practice Address - Country:US
Practice Address - Phone:305-933-8700
Practice Address - Fax:305-933-4051
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN006371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics