Provider Demographics
NPI:1891402780
Name:GENTILE, DOMINIC WILLIAM IV (MS CF-SLP)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:WILLIAM
Last Name:GENTILE
Suffix:IV
Gender:M
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 4TH AVE STE 904
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1462
Mailing Address - Country:US
Mailing Address - Phone:304-989-7465
Mailing Address - Fax:
Practice Address - Street 1:803 7TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2117
Practice Address - Country:US
Practice Address - Phone:304-523-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist