Individual
MICHAEL DAVID GENTILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
49 LAKE AVE, SUITE 203, GREENWICH, CT 06830-4501
(203) 869-2090
(203) 869-2535
Mailing address
49 LAKE AVE, SUITE 203, GREENWICH, CT 06830-4501
(203) 869-2090
(203) 869-2535
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
008565
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008565
DENTAL LICENSE
CT
Enumeration date
05/16/2007
Last updated
07/08/2007
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