Provider Demographics
NPI:1487774709
Name:GENOVESE, JANICE K (DDS)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:K
Last Name:GENOVESE
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 1:850 BERMUDA DUNES PL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3112
Mailing Address - Country:US
Mailing Address - Phone:847-480-6359
Mailing Address - Fax:
Practice Address - Street 1:10 W PHILLIP RD STE 105
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-680-7171
Practice Address - Fax:847-680-4601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice