Provider Demographics
NPI:1326781279
Name:HARTLAND GENTLE DENTAL, P.C.
Entity Type:Organization
Organization Name:HARTLAND GENTLE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BOUHANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-632-5364
Mailing Address - Street 1:11479 HIGHLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2737
Mailing Address - Country:US
Mailing Address - Phone:810-632-5364
Mailing Address - Fax:810-632-9576
Practice Address - Street 1:11479 HIGHLAND RD STE A
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2737
Practice Address - Country:US
Practice Address - Phone:810-632-5364
Practice Address - Fax:810-632-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental