Provider Demographics
NPI:1033799473
Name:VGENTLE
Entity Type:Organization
Organization Name:VGENTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-995-2634
Mailing Address - Street 1:394 W MAIN ST # 209
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2035
Mailing Address - Country:US
Mailing Address - Phone:801-796-2229
Mailing Address - Fax:385-374-9774
Practice Address - Street 1:394 W MAIN ST # 209
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2035
Practice Address - Country:US
Practice Address - Phone:801-796-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty