Provider Demographics
NPI:1902341373
Name:GENTLE DENTISTRY OF LANCASTER, PLLC
Entity Type:Organization
Organization Name:GENTLE DENTISTRY OF LANCASTER, PLLC
Other - Org Name:POUGHKEEPSIE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8972
Mailing Address - Street 1:22 IBM RD
Mailing Address - Street 2:STE 203B
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5455
Mailing Address - Country:US
Mailing Address - Phone:845-462-1542
Mailing Address - Fax:
Practice Address - Street 1:22 IBM RD
Practice Address - Street 2:STE 203B
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5455
Practice Address - Country:US
Practice Address - Phone:845-462-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENTLE DENTISTRY OF LANCASTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty