Provider Demographics
NPI:1447327416
Name:GENTLE DENTAL SERVICES LTD
Entity type:Organization
Organization Name:GENTLE DENTAL SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:BOZENA
Authorized Official - Last Name:KOZAR-WARCHALOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-364-5305
Mailing Address - Street 1:640 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5703
Mailing Address - Country:US
Mailing Address - Phone:847-364-5305
Mailing Address - Fax:847-364-7701
Practice Address - Street 1:640 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5703
Practice Address - Country:US
Practice Address - Phone:847-364-5305
Practice Address - Fax:847-364-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025425261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental