MEDICARE: DENNIS R GARDNER

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1427693159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS R GARDNER

Provider Business Mailing Address
First Line	:	5311 MAIN ST STE H
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-3155
Country	:	US
Telephone Number	:	931-486-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 MAIN ST STE H
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-3155
Country	:	US
Telephone Number	:	931-486-2949
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DENNIS GARDNER
Credential	:	DDS
Telephone Number	:	931-486-2949

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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