MEDICARE: GENTLE DENTISTRY INC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1932716859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE DENTISTRY INC

Provider Business Mailing Address
First Line	:	1810 S BOWEN RD STE A
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3340
Country	:	US
Telephone Number	:	817-274-8667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 S BOWEN RD STE A
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-3340
Country	:	US
Telephone Number	:	817-274-8667
Fax Number	:	817-328-2404

Authorized Official
Title or Position	:	OWNER
Name	:	RAVI DOCTOR
Credential	:	DDS
Telephone Number	:	817-274-8667

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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Directions to “GENTLE DENTISTRY INC ” Practice Location

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