Provider Demographics
NPI:1679015507
Name:GENTLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GENTLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEMECEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-547-9516
Mailing Address - Street 1:201 BRIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1381
Mailing Address - Country:US
Mailing Address - Phone:231-547-9516
Mailing Address - Fax:231-547-9526
Practice Address - Street 1:201 BRIDGE PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1381
Practice Address - Country:US
Practice Address - Phone:231-547-9516
Practice Address - Fax:231-547-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty