MEDICARE: GENTLE FAMILY DENTISTRY, P.C.

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	D7501	OR

General Provider Information

NPI Number	:	1780857953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 68479
Second Line	:
City	:	OAK GROVE
State	:	OR
Zip	:	97268-0479
Country	:	US
Telephone Number	:	503-786-5949
Fax Number	:

Provider Business Practice Location Address
First Line	:	17497 SE MCLOUGHLIN BLVD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-5906
Country	:	US
Telephone Number	:	503-786-5949
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	LISA POPESCU
Credential	:
Telephone Number	:	503-786-5949

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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