Provider Demographics
NPI:1245297548
Name:GENTLE DENTAL SPA P.C.
Entity type:Organization
Organization Name:GENTLE DENTAL SPA P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRO-KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-275-8336
Mailing Address - Street 1:2200 W HIGGINS RD STE 335
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2484
Mailing Address - Country:US
Mailing Address - Phone:847-490-8708
Mailing Address - Fax:847-490-9920
Practice Address - Street 1:2200 W HIGGINS RD STE 335
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2484
Practice Address - Country:US
Practice Address - Phone:847-490-8708
Practice Address - Fax:847-490-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-23708122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty