MEDICARE: GARRETT GENTLING DDS PLLC

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	261QD0000X	Dental Clinic/Center	DE60687419	WA

General Provider Information

NPI Number	:	1063929578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRETT GENTLING DDS PLLC

Provider Business Mailing Address
First Line	:	11720 97TH LN NE APT A413
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-8963
Country	:	US
Telephone Number	:	206-353-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 N 200TH ST STE 220
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98133-3213
Country	:	US
Telephone Number	:	206-353-5567
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARRETT GENTLING
Credential	:	DDS
Telephone Number	:	206-353-5567

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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