Provider Demographics
NPI:1578933305
Name:EZ GENTLE FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:EZ GENTLE FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-781-7272
Mailing Address - Street 1:56 FERGUSON ST
Mailing Address - Street 2:E-1
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:973-878-2689
Practice Address - Street 1:4175 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3730
Practice Address - Country:US
Practice Address - Phone:212-781-7272
Practice Address - Fax:212-781-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental