Healthcare Provider Details

I. General information

NPI: 1720110281
Provider Name (Legal Business Name): PAMELA ANN GENTILE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MILLER PARK WAY
WEST MILWAUKEE WI
53219-1641
US

IV. Provider business mailing address

7571 W TUCKAWAY PINES CIR
FRANKLIN WI
53132-8178
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-4540
  • Fax:
Mailing address:
  • Phone: 801-691-1701
  • Fax: 801-335-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6767
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1002478
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: