Individual
GARY LEE GENZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5720 SE FOSTER RD, PORTLAND, OR 97206-3866
(503) 774-5037
(503) 774-7128
Mailing address
5720 SE FOSTER RD, PORTLAND, OR 97206-3866
(503) 774-5037
(503) 774-7128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4522
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4522
OREGON DENTAL SCHOOL
OR
Enumeration date
12/21/2006
Last updated
07/08/2007
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