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Organization
GENTLE DENTAL
Active
Organization
GENTLE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA PHAN DMD (DENTIST)
(404) 499-2216
Entity
Organization
Contact information
Practice address
3595 HILL ST., CLARKSTON, GA 30021
(404) 499-2216
Mailing address
3595 HILL ST., CLARKSTON, GA 30021
(404) 499-2216
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012128
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00882824D
—
GA
Enumeration date
03/07/2007
Last updated
08/22/2020
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