Individual provider Active NPI

James M Gentile, D.D.S.

  • General Practice Dentistry
  • Boardman, OH
National Provider Identifier
1225001241
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3015046 Issued in OH
Practice address
6540 South Ave
Suite B
Boardman, OH 44512-3651
Phone
(330) 758-6165
Fax
(330) 758-0863
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3015046 OH Primary

Addresses

Primary practice location

6540 South Ave
Suite B
Boardman, OH 44512-3651

Mailing address

6540 South Ave
Suite B
Boardman, OH 44512-3651
Phone (330) 758-6165

Other identifiers 1

IdentifierTypeStateIssuer
0296166MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161028001875 OH Order and Referring Only - DentistPractitioner - Dentist 6204114085

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3015046OHMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225001241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6540 SOUTH AVE",
            "address_2": "SUITE B",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445123651",
            "telephone_number": "330-758-6165",
            "fax_number": "330-758-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 SOUTH AVE",
            "address_2": "SUITE B",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445123651",
            "telephone_number": "330-758-6165",
            "fax_number": "330-758-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTILE",
        "first_name": "JAMES",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "3015046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0296166",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.