Provider Demographics
NPI:1366492829
Name:GENTNER, DONALD S (MS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:S
Last Name:GENTNER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 S SAINT LOUIS BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3044
Mailing Address - Country:US
Mailing Address - Phone:574-232-1405
Mailing Address - Fax:574-232-0124
Practice Address - Street 1:211 W WASHINGTON ST
Practice Address - Street 2:SUITE 1910
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1704
Practice Address - Country:US
Practice Address - Phone:574-232-1405
Practice Address - Fax:574-232-0124
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN34002568A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR33376Medicare UPIN
IN217590AMedicare PIN