MEDICARE: GENTLE DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4779	WA

General Provider Information

NPI Number	:	1205089232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE DENTISTRY

Provider Business Mailing Address
First Line	:	2100 E SECTION ST STE 101
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-9132
Country	:	US
Telephone Number	:	360-424-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 E SECTION ST STE 101
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-9132
Country	:	US
Telephone Number	:	360-424-1990
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. HOWARD MIZUTA
Credential	:	DDS
Telephone Number	:	360-424-1990

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

Similar Medicare Providers

1053305953 — HOWARD M MIZUTA DDS
Practice Location Address:

2100 E SECTION ST , #101
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-424-1990
Practice Fax: 360-424-1994

1184717654 — DR. PETER EUIDON KIM D.D.S.
Practice Location Address:

2100 E SECTION ST STE 103
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-424-7057
Practice Fax: 360-424-7058

1548354319 — DR. BERNARD JOHN LARSON D.D.S.
Practice Location Address:

2100 E SECTION ST STE 102
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-428-3565
Practice Fax: 360-428-3593

1578863999 — EUNICE KIM, DDS, PLLC
Practice Location Address:

2100 E SECTION ST , SUITE 101
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-424-1990
Practice Fax: 360-424-1994

1215373931 — B. J. LARSON, D.D.S., P. S.
Practice Location Address:

2100 E SECTION ST STE 102
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-428-3565
Practice Fax: 360-428-3593

1457751273 — PETER E. KIM, DDS, PS
Practice Location Address:

2100 E SECTION ST STE 103
MOUNT VERNON, WA
98274-9132

Practice Phone: 360-424-7057
Practice Fax: 360-424-7058

Directions to “GENTLE DENTISTRY ” Practice Location

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