Provider Demographics
NPI:1093873523
Name:GENTRY SMILES
Entity Type:Organization
Organization Name:GENTRY SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-571-3415
Mailing Address - Street 1:11010 PRAIRIE BROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-571-3415
Mailing Address - Fax:402-571-1057
Practice Address - Street 1:11010 PRAIRIE BROOK ROAD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-571-3415
Practice Address - Fax:402-571-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty