Jasen Genninger

NPI #1780054593 in Brandon, Florida

Provider Information

NPI Number: 1780054593
Entity Type: Individual
Name: Jasen Genninger
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 6, 2015
Last Updated: Oct 6, 2015

Practice Location

Address: 511 W BRANDON BLVD
City: Brandon
State: Florida
ZIP Code: 33511-5003
Phone: (813) 381-5632

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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