Provider Demographics
NPI:1568575090
Name:GENTLES, JOHN EDGAR SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDGAR
Last Name:GENTLES
Suffix:SR
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 1:4143 N US HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2825
Mailing Address - Country:US
Mailing Address - Phone:314-355-1401
Mailing Address - Fax:314-355-5506
Practice Address - Street 1:4143 N US HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2825
Practice Address - Country:US
Practice Address - Phone:314-355-1401
Practice Address - Fax:314-355-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist