Provider Demographics
NPI:1427604214
Name:A GENTLE DENTAL CENTER OF ROBBINSDALE
Entity Type:Organization
Organization Name:A GENTLE DENTAL CENTER OF ROBBINSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:PUCEL
Authorized Official - Last Name:KOOPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-537-4531
Mailing Address - Street 1:4930 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1731
Mailing Address - Country:US
Mailing Address - Phone:763-537-4531
Mailing Address - Fax:
Practice Address - Street 1:4930 42ND AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1731
Practice Address - Country:US
Practice Address - Phone:763-537-4531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental