Healthcare Provider Details

I. General information

NPI: 1861516692
Provider Name (Legal Business Name): GENTLE DENTAL COLLINGDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-20 MACDADE BLVD A
COLLINGDALE PA
19023-2105
US

IV. Provider business mailing address

14-20 MACDADE BLVD A
COLLINGDALE PA
19023-2105
US

V. Phone/Fax

Practice location:
  • Phone: 610-534-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MIKE COLE
Title or Position: INSURANCE DIRECTOR
Credential:
Phone: 727-726-1611