Active NPI
Andrew John Gentile, DDS
- Dentist
- Austin, TX
National Provider Identifier
1053795039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31084
- Practice address
- 1110 W William Cannon Dr
Austin, TX 78745-5468 - Phone
- (512) 445-5811
- NPI assigned
- Jul 19, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 31084 | TX | Primary |
Addresses
Primary practice location
1110 W William Cannon Dr
Austin, TX 78745-5468
Mailing address
1620 E Riverside Dr
Apt 5037
Austin, TX 78741-1008
Phone (631) 897-8514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240229002954 | TX | Order and Referring Only - Oral Surgery | 9234574252 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31084 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439596800000",
"number": "1053795039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 E RIVERSIDE DR",
"address_2": "APT 5037",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787411008",
"telephone_number": "631-897-8514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 W WILLIAM CANNON DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787455468",
"telephone_number": "512-445-5811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTILE",
"first_name": "ANDREW",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-19",
"last_updated": "2015-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.