Provider Demographics
NPI:1609204460
Name:GENTLE FAMILY DENTAL OF ELMHURST
Entity Type:Organization
Organization Name:GENTLE FAMILY DENTAL OF ELMHURST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-335-3368
Mailing Address - Street 1:4 FRANKLIN PL
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9002 43RD AVE
Practice Address - Street 2:DENTAL OFFICE
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3472
Practice Address - Country:US
Practice Address - Phone:718-335-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty