MEDICARE: DR. BRETT M GARDINER 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
1	1223G0001X	General Practice Dentistry	875	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	821554	OTHER		UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912122821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT M GARDINER DDS

Provider Business Mailing Address
First Line	:	4000 OLD SEWARD HWY STE 100
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-6079
Country	:	US
Telephone Number	:	907-561-3639
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 OLD SEWARD HWY STE 100
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-6079
Country	:	US
Telephone Number	:	907-561-3639
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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