Provider Demographics
NPI:1538159918
Name:GENTLE FAMILY DENTAL CARE
Entity type:Organization
Organization Name:GENTLE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-262-5898
Mailing Address - Street 1:6972 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3221
Mailing Address - Country:US
Mailing Address - Phone:773-262-5898
Mailing Address - Fax:773-262-5897
Practice Address - Street 1:6972 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3221
Practice Address - Country:US
Practice Address - Phone:773-262-5898
Practice Address - Fax:773-262-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL105460Medicaid