Provider Demographics
NPI:1427137397
Name:GENTILE, LAWRENCE RICHARD (DDSFAGD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DDSFAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8136
Mailing Address - Country:US
Mailing Address - Phone:630-851-0450
Mailing Address - Fax:
Practice Address - Street 1:4260 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8136
Practice Address - Country:US
Practice Address - Phone:630-851-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A148481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice