Provider Demographics
NPI:1770760126
Name:JOEL A. GENTRY, DDS, PLLC
Entity type:Organization
Organization Name:JOEL A. GENTRY, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-886-4933
Mailing Address - Street 1:212 W LEXINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2534
Mailing Address - Country:US
Mailing Address - Phone:336-886-4933
Mailing Address - Fax:336-886-4485
Practice Address - Street 1:212 W LEXINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2534
Practice Address - Country:US
Practice Address - Phone:336-886-4933
Practice Address - Fax:336-886-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5708261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
549026OtherUNITED CONCORDIA
NC8993142Medicaid
NC6689340001OtherMEDICARE PTAN
AL81044434OtherBCBS- ALA
NC93142OtherBCBS NC