Provider Demographics
NPI:1053138859
Name:GENTLE DENTAL OF NEWBURGH PLLC
Entity type:Organization
Organization Name:GENTLE DENTAL OF NEWBURGH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIDAPET
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIDHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-561-3689
Mailing Address - Street 1:1450 ROUTE 300 STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2690
Mailing Address - Country:US
Mailing Address - Phone:845-561-3689
Mailing Address - Fax:
Practice Address - Street 1:1450 ROUTE 300 STE 202
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2690
Practice Address - Country:US
Practice Address - Phone:845-561-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1669642575OtherDOCTOR PETER LUCCHESE