Provider Demographics
NPI:1154477818
Name:GENTLE DENTAL MANAGEMENT LLC
Entity type:Organization
Organization Name:GENTLE DENTAL MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-338-8704
Mailing Address - Street 1:2930 CTY HWY NN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9288
Mailing Address - Country:US
Mailing Address - Phone:262-338-8704
Mailing Address - Fax:262-338-9140
Practice Address - Street 1:2930 CTY HWY NN
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9288
Practice Address - Country:US
Practice Address - Phone:262-338-8704
Practice Address - Fax:262-338-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI5624122300000X
WIWI2517K122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty