Provider Demographics
NPI:1851557151
Name:GENTLE TOUCH DENTISTRY, INC.
Entity Type:Organization
Organization Name:GENTLE TOUCH DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STOUTAMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-2828
Mailing Address - Street 1:2155 LOCH RANE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5719
Mailing Address - Country:US
Mailing Address - Phone:904-272-2828
Mailing Address - Fax:
Practice Address - Street 1:2155 LOCH RANE BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5719
Practice Address - Country:US
Practice Address - Phone:904-272-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN134971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty