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General NPI Number Information
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NPI Number | 1821237835
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Entity Type | Organization
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Legal Business Name | GENTLECARE FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 1341 S MILITARY HWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2513
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Country | US
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Telephone | 757-447-7333
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Fax | 757-394-3394
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Provider Business Mailing Address
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Address Line | 1341 S MILITARY HWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2513
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Country | US
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Telephone | 757-447-7333
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Fax | 757-394-3394
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Authorized Official
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Title or Position | CEO
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Name | DR. SEAN DO
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Credential | D.M.D.
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Telephone | 757-447-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0401411673
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License Number State | VA
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