MEDICARE: GENTLE TOUCH DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	45858	CA

General Provider Information

NPI Number	:	1003038910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE TOUCH DENTAL GROUP

Provider Business Mailing Address
First Line	:	8363 RESEDA BLVD
Second Line	:	11
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-882-0009
Fax Number	:	818-882-0011

Provider Business Practice Location Address
First Line	:	8363 RESEDA BLVD
Second Line	:	11
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-882-0009
Fax Number	:	818-882-0011

Authorized Official
Title or Position	:	OWNER
Name	:	IRINA FINGEROV
Credential	:	DOCTOR
Telephone Number	:	818-882-0009

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	01/23/2008

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