Provider Demographics
NPI:1922158641
Name:GENTLE DENTAL CENTER
Entity Type:Organization
Organization Name:GENTLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-236-6181
Mailing Address - Street 1:416 W WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1836
Mailing Address - Country:US
Mailing Address - Phone:859-236-6181
Mailing Address - Fax:859-236-5435
Practice Address - Street 1:416 W WALNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1836
Practice Address - Country:US
Practice Address - Phone:859-236-6181
Practice Address - Fax:859-236-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty