Provider Demographics
NPI:1821237835
Name:GENTLECARE FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:GENTLECARE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:757-447-7333
Mailing Address - Street 1:1341 S MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2513
Mailing Address - Country:US
Mailing Address - Phone:757-447-7333
Mailing Address - Fax:757-394-3394
Practice Address - Street 1:1341 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2513
Practice Address - Country:US
Practice Address - Phone:757-447-7333
Practice Address - Fax:757-394-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411673302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization