Provider Demographics
NPI:1033473145
Name:GENTRY, ADAM JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JEFFREY
Last Name:GENTRY
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 1:1921 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1325
Mailing Address - Country:US
Mailing Address - Phone:303-202-3550
Mailing Address - Fax:303-202-3551
Practice Address - Street 1:1921 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1325
Practice Address - Country:US
Practice Address - Phone:303-202-3550
Practice Address - Fax:303-202-3551
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist