Provider Demographics
NPI:1780857953
Name:GENTLE FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:GENTLE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-786-5949
Mailing Address - Street 1:PO BOX 68479
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0479
Mailing Address - Country:US
Mailing Address - Phone:503-786-5949
Mailing Address - Fax:
Practice Address - Street 1:17497 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-5906
Practice Address - Country:US
Practice Address - Phone:503-786-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty