Provider Demographics
NPI:1366824013
Name:GENTLE DENTISTRY, LLC
Entity Type:Organization
Organization Name:GENTLE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-457-5671
Mailing Address - Street 1:5139 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3430
Mailing Address - Country:US
Mailing Address - Phone:215-747-6453
Mailing Address - Fax:484-461-7666
Practice Address - Street 1:5139 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3430
Practice Address - Country:US
Practice Address - Phone:215-747-6453
Practice Address - Fax:484-461-7666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DREXEL HILL FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty