MEDICARE: GENTLE FAMILY DENTAL CARE

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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538159918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE FAMILY DENTAL CARE

Provider Business Mailing Address
First Line	:	6972 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3221
Country	:	US
Telephone Number	:	773-262-5898
Fax Number	:	773-262-5897

Provider Business Practice Location Address
First Line	:	6972 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3221
Country	:	US
Telephone Number	:	773-262-5898
Fax Number	:	773-262-5897

Authorized Official
Title or Position	:	OWNER
Name	:	NAHRAIN DINKHA
Credential	:	DDS
Telephone Number	:	773-262-5898

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/22/2020

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Directions to “GENTLE FAMILY DENTAL CARE ” Practice Location

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