Provider Demographics
NPI:1417150244
Name:BRENDA R. GENTRY DDS, PA
Entity Type:Organization
Organization Name:BRENDA R. GENTRY DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-252-7645
Mailing Address - Street 1:15803 WINDERMERE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2402
Mailing Address - Country:US
Mailing Address - Phone:512-252-7645
Mailing Address - Fax:
Practice Address - Street 1:15803 WINDERMERE DR
Practice Address - Street 2:STE 400
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2402
Practice Address - Country:US
Practice Address - Phone:512-252-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty