Provider Demographics
NPI:1942491154
Name:GENHO, BETH LORRAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:LORRAINE
Last Name:GENHO
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 1:15800 LAKE IOLA RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-7420
Mailing Address - Country:US
Mailing Address - Phone:352-524-5170
Mailing Address - Fax:
Practice Address - Street 1:37615 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3099
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229001223G0001X
FLHAD271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice