Provider Demographics
NPI:1689786014
Name:FAMILY GENTLE DENTISTS
Entity Type:Organization
Organization Name:FAMILY GENTLE DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-676-7122
Mailing Address - Street 1:23000 TELEGRAPH RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9265
Mailing Address - Country:US
Mailing Address - Phone:734-676-7122
Mailing Address - Fax:734-676-5326
Practice Address - Street 1:23000 TELEGRAPH RD
Practice Address - Street 2:SUITE #3
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-9265
Practice Address - Country:US
Practice Address - Phone:734-676-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty