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NPI Code Detail

MEDICARE: JAMES EDWARD GARDNER III DDS

MEDICARE: JAMES EDWARD GARDNER III DDS
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
11223G0001XGeneral Practice Dentistry24433FL

General Provider Information

NPI Number : 1679129878
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES EDWARD GARDNER III DDS
Provider Business Mailing Address
First Line : 5001 BRIDGE ST APT 2602
Second Line :
City : TAMPA
State : FL
Zip : 33611-3252
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14381 SPRING HILL DR
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-8199
Country : US
Telephone Number : 352-556-0029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 04/05/2021

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