Healthcare Provider Details

I. General information

NPI: 1114155009
Provider Name (Legal Business Name): JOHN GENTILE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 GLASS RD NE
CEDAR RAPIDS IA
52402-2503
US

IV. Provider business mailing address

409 TRAFTON RD
SPRINGFIELD MA
01108-2647
US

V. Phone/Fax

Practice location:
  • Phone: 319-395-7207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL10632
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberTP-0141
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: