Provider Demographics
NPI:1134335466
Name:GENTLE DENTAL CARE OF ROCHESTER PC
Entity type:Organization
Organization Name:GENTLE DENTAL CARE OF ROCHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:BOTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-467-4513
Mailing Address - Street 1:295 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3660
Mailing Address - Country:US
Mailing Address - Phone:585-467-4513
Mailing Address - Fax:585-467-4665
Practice Address - Street 1:295 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3660
Practice Address - Country:US
Practice Address - Phone:585-467-4513
Practice Address - Fax:585-467-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02289081Medicaid
NY02646986Medicaid
NY02667485Medicaid
NY01431401Medicaid
NY02808359Medicaid
NY02901348Medicaid