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Organization
GENTLE FAMILY DENTISTRY, P.C.
Active
Organization
GENTLE FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN C. WENTZ DDS (PRESIDENT)
(208) 476-4315
Entity
Organization
Contact information
Practice address
1265 AHSAHKA RD, OROFINO, ID 83544-9025
(208) 476-4315
(208) 476-4353
Mailing address
PO BOX 748, OROFINO, ID 83544-0748
(208) 476-4315
(208) 476-4353
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D2073
ID
1223G0001X
General Practice Dentistry
D3474
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10029033
REGENCE BLUE SHIELD
ID
01
—
62073
WASHINGTON DENTAL SERVICE
ID
01
—
723020
UNITED CONCORDIA
ID
01
—
I 93452
REGENCE BLUE SHIELD
ID
01
—
I90841
REGENCE BLUE SHIELD
ID
Enumeration date
11/20/2006
Last updated
08/22/2020
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