Provider Demographics
NPI:1932522828
Name:GENISH, ADI AVITAL (DDS)
Entity type:Individual
Prefix:DR
First Name:ADI
Middle Name:AVITAL
Last Name:GENISH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 COWPER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304
Mailing Address - Country:US
Mailing Address - Phone:818-335-0654
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD. 11
Practice Address - Street 2:SUITE #210
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3736
Practice Address - Country:US
Practice Address - Phone:818-335-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist