MEDICARE: GENTLE TOUCH 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	1223G0001X	General Practice Dentistry	DN013218	GA

General Provider Information

NPI Number	:	1942688247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE TOUCH DENTISTRY LLC

Provider Business Mailing Address
First Line	:	3970 FIVE FORKS TRICKUM RD SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-2339
Country	:	US
Telephone Number	:	770-921-8443
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 FIVE FORKS TRICKUM RD SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-2339
Country	:	US
Telephone Number	:	770-921-8443
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. ASHISH VAKHARIA
Credential	:	DMD
Telephone Number	:	412-716-7907

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	05/07/2015

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