MEDICARE: JEANETTE COUTIN-GENTRY D.D.S

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	0401007503	WA

General Provider Information

NPI Number	:	1528277837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE COUTIN-GENTRY D.D.S

Provider Business Mailing Address
First Line	:	1831 WILSON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3002
Country	:	US
Telephone Number	:	703-522-7733
Fax Number	:	703-528-7341

Provider Business Practice Location Address
First Line	:	1831 WILSON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3002
Country	:	US
Telephone Number	:	703-522-7733
Fax Number	:	703-528-7341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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