Provider Demographics
NPI:1760505606
Name:MICHAEL JAMES GENGLE DDS LLC
Entity Type:Organization
Organization Name:MICHAEL JAMES GENGLE DDS LLC
Other - Org Name:MICHAEL J GENGLE DDS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-878-6476
Mailing Address - Street 1:6390 W BELL RD
Mailing Address - Street 2:A1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3613
Mailing Address - Country:US
Mailing Address - Phone:623-878-6476
Mailing Address - Fax:
Practice Address - Street 1:6390 W BELL RD
Practice Address - Street 2:A1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3613
Practice Address - Country:US
Practice Address - Phone:623-878-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental