Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8931 | TN |
NPI | 1053557744 |
---|---|
Provider Name | Dr. Samuel Isaac Gentry |
First Address | Clarksville, TN 37043-8846 |
Second Address | Clarksville, TN 37043-8846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 30/12/2008 |