MEDICARE: GENTLE TOUCH FAMILY DENTISTRY, PC

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	8739	TN

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	:	1790078988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE TOUCH FAMILY DENTISTRY, PC

Provider Business Mailing Address
First Line	:	8090 HIGHWAY 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-4212
Country	:	US
Telephone Number	:	615-891-1853
Fax Number	:	615-891-1855

Provider Business Practice Location Address
First Line	:	8090 HIGHWAY 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-4212
Country	:	US
Telephone Number	:	615-891-1853
Fax Number	:	615-891-1855

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. KEVIN T BOLDEN
Credential	:	DDS
Telephone Number	:	615-891-1853

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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