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General NPI Number Information
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NPI Number | 1710314349
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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 | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 901 STEWART AVE SUITE 206
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City | GARDEN CITY
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State | NY
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Zip | 11530-4893
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Country | US
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Telephone | 210-293-0696
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Fax | 210-520-3424
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Provider Business Mailing Address
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Address Line | 901 STEWART AVE SUITE 206
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City | GARDEN CITY
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State | NY
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Zip | 11530-4893
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Country | US
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Telephone | 210-293-0696
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Fax | 210-520-3424
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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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