Provider Demographics
NPI:1437201365
Name:GENTLE DENTISTRY OF COLUMBUS, P.C.
Entity Type:Organization
Organization Name:GENTLE DENTISTRY OF COLUMBUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEERSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-322-6551
Mailing Address - Street 1:1846 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8029
Mailing Address - Country:US
Mailing Address - Phone:706-322-6551
Mailing Address - Fax:706-576-5154
Practice Address - Street 1:1846 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8029
Practice Address - Country:US
Practice Address - Phone:706-322-6551
Practice Address - Fax:706-576-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0089491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty