Provider Demographics
NPI:1699784884
Name:GENCO, GERARD THOMES (GERARD GENCO)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:THOMES
Last Name:GENCO
Suffix:
Gender:M
Credentials:GERARD GENCO
Other - Prefix:
Other - First Name:GERARD
Other - Middle Name:
Other - Last Name:GENCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GERARD GENCO
Mailing Address - Street 1:1030 GREEN RIDGE ST
Mailing Address - Street 2:SCRANTON
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1929
Mailing Address - Country:US
Mailing Address - Phone:570-342-5001
Mailing Address - Fax:570-342-1635
Practice Address - Street 1:1030 GREEN RIDGE ST
Practice Address - Street 2:SCRANTON
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1929
Practice Address - Country:US
Practice Address - Phone:570-342-5001
Practice Address - Fax:570-342-1635
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030379-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice