Provider Demographics
NPI:1790949329
Name:GENTLEDENTAL GENERAL DENTISTRY P.C.
Entity Type:Organization
Organization Name:GENTLEDENTAL GENERAL DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ATANACIO
Authorized Official - Last Name:MANALAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-220-0083
Mailing Address - Street 1:586 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4744
Mailing Address - Country:US
Mailing Address - Phone:646-220-0083
Mailing Address - Fax:
Practice Address - Street 1:586 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4744
Practice Address - Country:US
Practice Address - Phone:646-220-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587777Medicaid