Provider Demographics
NPI:1174622328
Name:GENEWICK, STEPHEN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:GENEWICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CENTRAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1262
Mailing Address - Country:US
Mailing Address - Phone:716-684-5394
Mailing Address - Fax:716-684-5395
Practice Address - Street 1:3083 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1933
Practice Address - Country:US
Practice Address - Phone:716-668-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist