Provider Demographics
NPI:1346608494
Name:GENTLECARE DENTAL, LLC
Entity Type:Organization
Organization Name:GENTLECARE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-314-7211
Mailing Address - Street 1:683 FARMINGTON AVE
Mailing Address - Street 2:STORE #23
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3974
Mailing Address - Country:US
Mailing Address - Phone:201-314-7211
Mailing Address - Fax:
Practice Address - Street 1:683 FARMINGTON AVE
Practice Address - Street 2:STORE #23
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3974
Practice Address - Country:US
Practice Address - Phone:201-314-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty