Provider Demographics
NPI:1679694467
Name:AMY M GENTNER DDS PC
Entity Type:Organization
Organization Name:AMY M GENTNER DDS PC
Other - Org Name:GENTNER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GENTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-224-7559
Mailing Address - Street 1:907 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2435
Mailing Address - Country:US
Mailing Address - Phone:989-224-7559
Mailing Address - Fax:989-224-2704
Practice Address - Street 1:907 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2435
Practice Address - Country:US
Practice Address - Phone:989-224-7559
Practice Address - Fax:989-224-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty