Provider Demographics
NPI:1609994136
Name:GENTLE TOUCH DENTAL
Entity Type:Organization
Organization Name:GENTLE TOUCH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:INNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-760-7566
Mailing Address - Street 1:1360 DOGWOOD DR SE
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5075
Mailing Address - Country:US
Mailing Address - Phone:770-760-7566
Mailing Address - Fax:770-760-9238
Practice Address - Street 1:1360 DOGWOOD DR SE
Practice Address - Street 2:SUITE 202B
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5075
Practice Address - Country:US
Practice Address - Phone:770-760-7566
Practice Address - Fax:770-760-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty