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General NPI Number Information
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NPI Number | 1225247414
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Entity Type | Organization
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Legal Business Name | GENTRY & COUTIN D.D.S. P.C.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1831 WILSON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22201-3002
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Country | US
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Telephone | 3
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Fax | 703-528-7341
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Provider Business Mailing Address
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Address Line | 1831 WILSON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22201-3002
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Country | US
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Telephone | 3
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Fax | 703-528-7341
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Authorized Official
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Title or Position | DENTIST
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Name | PHILIP A GENTRY
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Credential | D.D.S., F.A.G.D.
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Telephone | 3
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007345
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License Number State | WA
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