Provider Demographics
NPI:1679198121
Name:GENT, AMBER JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:JORDAN
Last Name:GENT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DRUMRIGHT
Mailing Address - State:OK
Mailing Address - Zip Code:74030-5826
Mailing Address - Country:US
Mailing Address - Phone:918-352-3312
Mailing Address - Fax:
Practice Address - Street 1:1226 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DRUMRIGHT
Practice Address - State:OK
Practice Address - Zip Code:74030-5826
Practice Address - Country:US
Practice Address - Phone:918-352-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist