Provider Demographics
NPI:1053573790
Name:GENESER, TERESA S (DMD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:GENESER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TERESEA
Other - Middle Name:S
Other - Last Name:MONIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1962 1ST AVE NE
Mailing Address - Street 2:CEDAR RAPIDS PEDIATRIC DENTISTRY
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5330
Mailing Address - Country:US
Mailing Address - Phone:319-364-2413
Mailing Address - Fax:319-364-8179
Practice Address - Street 1:2218 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6347
Practice Address - Country:US
Practice Address - Phone:319-364-2413
Practice Address - Fax:319-364-8179
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087951223P0221X
RILD000351223G0001X
IA302881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice