Provider Demographics
NPI:1033637921
Name:GENTLE DENTISTRY OF LANCASTER, PLLC
Entity Type:Organization
Organization Name:GENTLE DENTISTRY OF LANCASTER, PLLC
Other - Org Name:MANOR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8972
Mailing Address - Street 1:66 COVERT AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3826
Mailing Address - Country:US
Mailing Address - Phone:516-775-2330
Mailing Address - Fax:
Practice Address - Street 1:66 COVERT AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3826
Practice Address - Country:US
Practice Address - Phone:516-775-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENTLE DENTISTRY OF LANCASTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty