MEDICARE: GENTLE DENTAL GROUP CORP

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

General Provider Information

NPI Number	:	1144053562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE DENTAL GROUP CORP

Provider Business Mailing Address
First Line	:	2701 W OAKLAND PARK BLVD STE 101
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1348
Country	:	US
Telephone Number	:	800-634-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W OAKLAND PARK BLVD STE 101
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1348
Country	:	US
Telephone Number	:	800-634-3479
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER/P
Name	:	YORIE GOUBOTH
Credential	:
Telephone Number	:	754-286-1554

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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