Provider Demographics
NPI:1235747718
Name:THE GENTLE DENTIST
Entity Type:Organization
Organization Name:THE GENTLE DENTIST
Other - Org Name:THE GENTLE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANTOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-247-3500
Mailing Address - Street 1:15055 22 MILE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4401
Mailing Address - Country:US
Mailing Address - Phone:586-247-3500
Mailing Address - Fax:
Practice Address - Street 1:15055 22 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4401
Practice Address - Country:US
Practice Address - Phone:586-247-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental