Provider Demographics
NPI:1700980208
Name:BAYAREA GENTLE DENTAL
Entity Type:Organization
Organization Name:BAYAREA GENTLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:RANGAPPA
Authorized Official - Last Name:RANGAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-842-9934
Mailing Address - Street 1:1309 W FAIRMONT PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6123
Mailing Address - Country:US
Mailing Address - Phone:281-842-9934
Mailing Address - Fax:
Practice Address - Street 1:1309 W FAIRMONT PKWY STE C
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6123
Practice Address - Country:US
Practice Address - Phone:281-842-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty