MEDICARE: GENTLE DENTISTRY, LLC

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	122300000X	Dentist	DS035539	PA

General Provider Information

NPI Number	:	1366824013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	5139 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3430
Country	:	US
Telephone Number	:	215-747-6453
Fax Number	:	484-461-7666

Provider Business Practice Location Address
First Line	:	5139 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3430
Country	:	US
Telephone Number	:	215-747-6453
Fax Number	:	484-461-7666

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DINESH S TEWARI
Credential	:	DMD
Telephone Number	:	610-457-5671

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	06/18/2015

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