Healthcare Provider Details

I. General information

NPI: 1689598542
Provider Name (Legal Business Name): RUSSELL W GARDNER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N 13TH ST
ROGERS AR
72756-3434
US

IV. Provider business mailing address

13995 BYLER RD
GARFIELD AR
72732-9514
US

V. Phone/Fax

Practice location:
  • Phone: 479-903-1243
  • Fax:
Mailing address:
  • Phone: 479-903-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL WARD GARDNER
Title or Position: DENTIST
Credential: DDS
Phone: 479-903-1243