Provider Demographics
NPI:1942543293
Name:GENTLE DENTAL CENTER
Entity Type:Organization
Organization Name:GENTLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-431-1300
Mailing Address - Street 1:3497 HOLLAND RD
Mailing Address - Street 2:SUITE 112/113
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4867
Mailing Address - Country:US
Mailing Address - Phone:757-431-1300
Mailing Address - Fax:757-431-1311
Practice Address - Street 1:3497 HOLLAND RD
Practice Address - Street 2:SUITE 112/113
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4867
Practice Address - Country:US
Practice Address - Phone:757-431-1300
Practice Address - Fax:757-431-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty