Provider Demographics
NPI:1225001241
Name:GENTILE, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 SOUTH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3651
Mailing Address - Country:US
Mailing Address - Phone:330-758-6165
Mailing Address - Fax:330-758-0863
Practice Address - Street 1:6540 SOUTH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3651
Practice Address - Country:US
Practice Address - Phone:330-758-6165
Practice Address - Fax:330-758-0863
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30150461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0296166Medicaid