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General NPI Number Information
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NPI Number | 1760778302
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Entity Type | Organization
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Legal Business Name | GORDON A. KENT, DMD, PC, DBA SMILE CENTER
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 4427 UNION ROAD
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225
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Country | US
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Telephone | 716-634-4090
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Fax | 716-634-4136
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Provider Business Mailing Address
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Address Line | 4427 UNION ROAD
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225
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Country | US
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Telephone | 716-634-4090
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Fax | 716-634-4136
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. GORDON A. KENT
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Credential | D.M.D.
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Telephone | 716-634-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 034309
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License Number State | NY
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