Provider Demographics
NPI:1790708642
Name:GENTRY, JOEL ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ALEXANDER
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W LEXINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 W LEXINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2534
Practice Address - Country:US
Practice Address - Phone:336-886-4933
Practice Address - Fax:336-886-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC5708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
549026OtherUNITED CONCORDIA
AL81044434OtherBLUE CROSS
NC8993142Medicaid
NC93142OtherBLUE CROSS