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General NPI Number Information
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NPI Number | 1902077001
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Entity Type | Organization
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Legal Business Name | GENTLE DENTAL CARE PLLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 1601 12TH AVE RD STE 103
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City | NAMPA
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State | ID
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Zip | 83686-6185
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Country | US
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Telephone | 208-467-9690
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Fax | 208-466-0412
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Provider Business Mailing Address
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Address Line | 1601 12TH AVE RD STE 103
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City | NAMPA
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State | ID
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Zip | 83686-6185
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Country | US
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Telephone | 208-467-9690
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Fax | 208-466-0412
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Authorized Official
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Title or Position | DENTIST
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Name | MARK T. MCDONALD
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Credential | D.D.S.
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Telephone | 208-467-9690
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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 | D3958
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License Number State | ID
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