Healthcare Provider Details

I. General information

NPI: 1699134015
Provider Name (Legal Business Name): GENTLE CARING DENTISTRY OF FREMONT OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 ENTERPRISE ST
FREMONT OH
43420
US

IV. Provider business mailing address

2430 ENTERPRISE ST
FREMONT OH
43420
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-1303
  • Fax: 419-332-0805
Mailing address:
  • Phone: 419-332-1303
  • Fax: 419-332-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30023596
License Number StateOH

VIII. Authorized Official

Name: RENEE BOWMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-332-1303