Provider Demographics
NPI:1467476960
Name:GENTRY, HARRY A (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:A
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7058
Mailing Address - Country:US
Mailing Address - Phone:770-945-5850
Mailing Address - Fax:
Practice Address - Street 1:3585 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7058
Practice Address - Country:US
Practice Address - Phone:770-945-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist