Basic Information
Provider Information | |||||||||
NPI: | 1063745941 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GENTLES | ||||||||
FirstName: | DENISE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GENTLES-FORD | ||||||||
OtherFirstName: | DENISE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 2702 N 3RD ST STE 4020 | ||||||||
Address2: |   | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850044608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6023233345 | ||||||||
FaxNumber: | 6023233399 | ||||||||
Practice Location | |||||||||
Address1: | 6601 W THOMAS RD | ||||||||
Address2: |   | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850335700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6022437277 | ||||||||
FaxNumber: | 6232479742 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/10/2009 | ||||||||
LastUpdateDate: | 04/02/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A98725 | CA | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207VG0400X | 48658 | AZ | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.