Provider Demographics
NPI:1891900452
Name:SOUTHWEST GD DENTAL CORP, PC
Entity Type:Organization
Organization Name:SOUTHWEST GD DENTAL CORP, PC
Other - Org Name:DBA GENTLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-449-5700
Mailing Address - Street 1:1101 SE TECH CENTER DRIVE, SUITE 195
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-449-5700
Mailing Address - Fax:360-449-5715
Practice Address - Street 1:1101 SE TECH CENTER DRIVE, SUITE 195
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-449-5670
Practice Address - Fax:360-449-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty