Provider Demographics
NPI:1134372246
Name:GENTRY, ROBERT BROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BROOKS
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 KENNEDY LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:540-786-0116
Mailing Address - Fax:540-786-7563
Practice Address - Street 1:12100 KENNEDY LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-786-0116
Practice Address - Fax:540-786-7563
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-00-6984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist