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General NPI Number Information
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NPI Number | 1538233457
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Entity Type | Organization
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Legal Business Name | GENTLE FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1265 AHSAHKA RD
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City | OROFINO
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State | ID
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Zip | 83544-9025
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Country | US
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Telephone | 208-476-4315
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Fax | 208-476-4353
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Provider Business Mailing Address
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Address Line | PO BOX 748
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City | OROFINO
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State | ID
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Zip | 83544-0748
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Country | US
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Telephone | 208-476-4315
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Fax | 208-476-4353
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN C. WENTZ
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Credential | DDS
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Telephone | 208-476-4315
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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 | D3474
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D2073
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License Number State | ID
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