MEDICARE: GENTLE CARE 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	122300000X	Dentist	DD4333	OK

General Provider Information

NPI Number	:	1922484922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE CARE DENTISTRY

Provider Business Mailing Address
First Line	:	2980 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1152
Country	:	US
Telephone Number	:	575-524-3722
Fax Number	:	575-524-9826

Provider Business Practice Location Address
First Line	:	2980 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1152
Country	:	US
Telephone Number	:	575-524-3722
Fax Number	:	575-524-9826

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DOMINIC MARKETTO THOMAS
Credential	:	DDS
Telephone Number	:	575-524-3722

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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Directions to “GENTLE CARE DENTISTRY ” Practice Location

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