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NPI Code Detail

MEDICARE: DR. BRETT M GARDINER DDS

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
11223G0001XGeneral Practice Dentistry875AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1821554OTHERUNITED CONCORDIA
2MEDICAID 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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