Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 19420 | OH |
NPI | 1093701245 |
---|---|
Provider Name | Dr. John A Gennantonio |
First Address | Cincinnati, OH 45255-4211 |
Second Address | Cincinnati, OH 45255-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0924807 | (05) | OH |