Provider Demographics
NPI:1134241714
Name:GENTLE DENTISTRY OF NEWNAN, PC
Entity type:Organization
Organization Name:GENTLE DENTISTRY OF NEWNAN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-683-6030
Mailing Address - Street 1:37 CALUMET PKWY # G
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6734
Mailing Address - Country:US
Mailing Address - Phone:770-683-6030
Mailing Address - Fax:
Practice Address - Street 1:37 CALUMET PKWY # G
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-683-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty