Provider Demographics
NPI:1124237482
Name:GENTLE DENTAL, PLLC
Entity type:Organization
Organization Name:GENTLE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARRIO
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-537-0077
Mailing Address - Street 1:670 COLONIAL RD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5160
Mailing Address - Country:US
Mailing Address - Phone:901-537-0077
Mailing Address - Fax:901-537-0088
Practice Address - Street 1:670 COLONIAL RD
Practice Address - Street 2:SUITE # 6
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5160
Practice Address - Country:US
Practice Address - Phone:901-537-0077
Practice Address - Fax:901-537-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007671261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental