Provider Demographics
NPI:1205089232
Name:GENTLE DENTISTRY
Entity type:Organization
Organization Name:GENTLE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-424-1990
Mailing Address - Street 1:2100 E SECTION ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9132
Mailing Address - Country:US
Mailing Address - Phone:360-424-1990
Mailing Address - Fax:
Practice Address - Street 1:2100 E SECTION ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9132
Practice Address - Country:US
Practice Address - Phone:360-424-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty