Provider Demographics
NPI:1871795641
Name:GENUNG, RICHARD CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:GENUNG
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 1:21 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2146
Mailing Address - Country:US
Mailing Address - Phone:973-625-3576
Mailing Address - Fax:973-625-8514
Practice Address - Street 1:21 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2146
Practice Address - Country:US
Practice Address - Phone:973-625-3576
Practice Address - Fax:973-625-8514
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DL01170700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist