Provider Demographics
NPI:1215102124
Name:GENTLE CARE FAMILY DENTISTRY, ELVIE C. NATHANSON D.M.D., INC.
Entity type:Organization
Organization Name:GENTLE CARE FAMILY DENTISTRY, ELVIE C. NATHANSON D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIE
Authorized Official - Middle Name:CERVAS
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-420-1144
Mailing Address - Street 1:340 4TH AVE.
Mailing Address - Street 2:SUITE 16
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3896
Mailing Address - Country:US
Mailing Address - Phone:619-420-1144
Mailing Address - Fax:619-420-2373
Practice Address - Street 1:340 4TH AVE.
Practice Address - Street 2:SUITE 16
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3896
Practice Address - Country:US
Practice Address - Phone:619-420-1144
Practice Address - Fax:619-420-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty