Provider Demographics
NPI:1144053562
Name:GENTLE DENTAL GROUP CORP
Entity type:Organization
Organization Name:GENTLE DENTAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/P
Authorized Official - Prefix:
Authorized Official - First Name:YORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUBOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-286-1554
Mailing Address - Street 1:2701 W OAKLAND PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1348
Mailing Address - Country:US
Mailing Address - Phone:800-634-3479
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1348
Practice Address - Country:US
Practice Address - Phone:800-634-3479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental