Active NPI
Dwayne Gentry, DMD
- Dentist
- Dyess AFB, TX
National Provider Identifier
1821420811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 83619819922
- Practice address
- 75 MDG Dental Clinic
697 Louisiana
Dyess AFB, TX 77960 - Phone
- (325) 696-2304
- NPI assigned
- Aug 1, 2013
- 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 | 83619819922 | UT | Primary |
Addresses
Primary practice location
75 MDG Dental Clinic
697 Louisiana
Dyess AFB, TX 77960
Mailing address
7 MDG
697 Louisiana
Dyess AFB, TX 79607
Phone (325) 696-2304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83619819922 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689811200000",
"number": "1821420811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 MDG",
"address_2": "697 LOUISIANA",
"city": "DYESS AFB",
"state": "TX",
"postal_code": "79607",
"telephone_number": "325-696-2304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 MDG DENTAL CLINIC",
"address_2": "697 LOUISIANA",
"city": "DYESS AFB",
"state": "TX",
"postal_code": "77960",
"telephone_number": "325-696-2304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "DWAYNE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-01",
"last_updated": "2023-07-20",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "83619819922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyess AFB, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.