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General NPI Number Information
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NPI Number | 1164611083
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Entity Type | Individual
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Provider Name | LAURA E GREEN GENTILE AUD, CCC-A
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Gender | Female
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1130 BEACHVIEW ST SUITE 240
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 214-324-0418
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Fax | 214-324-0693
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Provider Business Mailing Address
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Address Line | 1130 BEACHVIEW ST SUITE 240
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 214-324-0418
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Fax | 214-324-0693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 50934
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License Number State | TX
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