Provider Demographics
NPI:1093875981
Name:GENTLE COSMETIC AND LASER DENTISTRY, LLC
Entity Type:Organization
Organization Name:GENTLE COSMETIC AND LASER DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-597-6990
Mailing Address - Street 1:1943 MERRIMAC DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3190
Mailing Address - Country:US
Mailing Address - Phone:732-929-0413
Mailing Address - Fax:
Practice Address - Street 1:169 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2933
Practice Address - Country:US
Practice Address - Phone:609-597-6990
Practice Address - Fax:609-597-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1015476001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty