Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | LD00035 | RI |
N | 213EG0000X | General Practice | LD00035 | RI |
Y | 1223P0221X | Pediatric Dentist | 08795 | IA |
N | 1223P0221X | Pediatric Dentist | 30288 | IA |
NPI | 1053573790 |
---|---|
Provider Name | Teresa S Geneser |
First Address | Cedar Rapids, IA 52402-5330 |
Second Address | Cedar Rapids, IA 52402-6347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 05/11/2019 |