Provider Demographics
NPI:1801448030
Name:GENTLE FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:GENTLE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:765-482-1060
Mailing Address - Street 1:1705 INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2936
Mailing Address - Country:US
Mailing Address - Phone:765-482-1060
Mailing Address - Fax:
Practice Address - Street 1:1705 INDIANAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2936
Practice Address - Country:US
Practice Address - Phone:765-482-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty