1447395405 NPI number — DAN L GENTILE LP

Table of content: DAN L GENTILE LP (NPI 1447395405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447395405 NPI number — DAN L GENTILE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENTILE
Provider First Name:
DAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447395405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 N 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEVIDEO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-235-4613
Provider Business Mailing Address Fax Number:
320-231-9140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 6TH STREET SE
Provider Second Line Business Practice Location Address:
WOODLAND CENTERS
Provider Business Practice Location Address City Name:
WILMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-4675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-231-9148
Provider Business Practice Location Address Fax Number:
320-231-9140
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP 3911 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)