Provider Demographics
NPI:1598895989
Name:GENTLE DENTAL CARE P.C.
Entity Type:Organization
Organization Name:GENTLE DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GENTLE DENTAL CARE P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-372-3327
Mailing Address - Street 1:1230 HILARY LANE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035
Mailing Address - Country:US
Mailing Address - Phone:847-831-4412
Mailing Address - Fax:847-831-4413
Practice Address - Street 1:5137 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2904
Practice Address - Country:US
Practice Address - Phone:773-378-4694
Practice Address - Fax:773-378-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty