Provider Demographics
NPI:1922271642
Name:RICHARD H. GENTZLER, III, DDS PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:RICHARD H. GENTZLER, III, DDS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-443-3633
Mailing Address - Street 1:106 BABB DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2506
Mailing Address - Country:US
Mailing Address - Phone:615-443-3633
Mailing Address - Fax:615-443-3696
Practice Address - Street 1:106 BABB DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2506
Practice Address - Country:US
Practice Address - Phone:615-443-3633
Practice Address - Fax:615-443-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440700Medicaid