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General NPI Number Information
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NPI Number | 1568898740
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Entity Type | Organization
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Legal Business Name | GENTLE DENTISTRY OF LANCASTER, PLLC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 3 WASHINGTON SQUARE VLG SUITE 1 B& D
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City | NEW YORK
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State | NY
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Zip | 10012-1836
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Country | US
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Telephone | 212-477-4330
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Fax | 212-674-2290
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Provider Business Mailing Address
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Address Line | 3 WASHINGTON SQUARE VLG SUITE 1 B& D
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City | NEW YORK
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State | NY
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Zip | 10012-1836
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Country | US
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Telephone | 212-477-4330
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Fax | 212-674-2290
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Authorized Official
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Title or Position | CRED. SUPERVISOR
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Name | KIM WILSON
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Credential |
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Telephone | 217-540-5170
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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 |
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License Number State |
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