Individual
GENTAI NI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
20639 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8461
(253) 862-0194
(253) 862-9068
Mailing address
20639 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8461
(253) 862-0194
(253) 862-9068
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE61007817
WA
1223G0001X
General Practice Dentistry
Primary
DE61007817
WA
Other
Enumeration date
07/30/2019
Last updated
10/10/2021
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