Provider Demographics
NPI:1609990860
Name:FAMILY CARE GENTLE DENTAL CTR, P.C.
Entity Type:Organization
Organization Name:FAMILY CARE GENTLE DENTAL CTR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-233-0155
Mailing Address - Street 1:11606 S. WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-233-0155
Mailing Address - Fax:773-233-9941
Practice Address - Street 1:11606 S. WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-233-0155
Practice Address - Fax:773-233-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty