# GENTLE DENTAL JEFFERSON PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831336502
- **Authorized official:** MICHAEL COLE (INSURANCE DIRECTOR)
- **Authorized official phone:** (727) 726-1611

## Contact information

- **Practice address:** 529 E JEFFERSON AVE, DETROIT, MI 48226-4324
- **Practice address phone:** (313) 963-3336
- **Practice address fax:** (313) 963-6464
- **Mailing address:** 529 E JEFFERSON AVE, DETROIT, MI 48226-4324

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2009
- **Last updated:** 01/16/2009