Individual
BETH MACK GENTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
102 N ADELAIDE ST, FENTON, MI 48430-2670
(810) 629-2245
(810) 629-6535
Mailing address
5163 E HOLLY RD, HOLLY, MI 48442-9746
(248) 634-8840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MM0921735
MEDICARE RR ID
MI
Enumeration date
03/03/2006
Last updated
01/07/2009
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