Provider Demographics
NPI:1215484423
Name:GENTLE DENTAL CARE SC
Entity type:Organization
Organization Name:GENTLE DENTAL CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:715-235-7566
Mailing Address - Street 1:1813 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1406
Mailing Address - Country:US
Mailing Address - Phone:715-235-7566
Mailing Address - Fax:715-235-7578
Practice Address - Street 1:1813 WILSON ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1406
Practice Address - Country:US
Practice Address - Phone:715-235-7566
Practice Address - Fax:715-235-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6724-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty