MEDICARE: DR. JOEL P. GARDNER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE00008421	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58421	OTHER	WA	WASHINGTON DENTAL SERVICE
2	518176	OTHER	WA	UNITED CONCORDIA TRICARE

General Provider Information

NPI Number	:	1265657522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL P. GARDNER DMD

Provider Business Mailing Address
First Line	:	1210 E DIVISION ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4102
Country	:	US
Telephone Number	:	360-336-5464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 E DIVISION ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4102
Country	:	US
Telephone Number	:	360-336-5464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	03/20/2026

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