Provider Demographics
NPI:1144415183
Name:GENTLE CARE DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GENTLE CARE DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:SAN NICOLAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:671-646-8858
Mailing Address - Street 1:278 SOUTH MARINE CORP DRIVE
Mailing Address - Street 2:HENGI PLAZA SUITE 102
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931
Mailing Address - Country:US
Mailing Address - Phone:671-646-8858
Mailing Address - Fax:671-646-3578
Practice Address - Street 1:278 SOUTH MARINE CORP DRIVE
Practice Address - Street 2:HENGI PLAZA SUITE 102
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96931
Practice Address - Country:US
Practice Address - Phone:671-646-8858
Practice Address - Fax:671-646-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty