Provider Demographics
NPI:1497880942
Name:DELAWARE GENTLE DENTAL GROUP
Entity Type:Organization
Organization Name:DELAWARE GENTLE DENTAL GROUP
Other - Org Name:GENTLE TOUCH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-514-6200
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1111
Mailing Address - Country:US
Mailing Address - Phone:302-514-6200
Mailing Address - Fax:302-514-6204
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1111
Practice Address - Country:US
Practice Address - Phone:302-514-6200
Practice Address - Fax:302-514-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental