Healthcare Provider Details

I. General information

NPI: 1790471993
Provider Name (Legal Business Name): SARAH M. GARDNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 24TH ST
ROGERS AR
72756-3591
US

IV. Provider business mailing address

1510 SHOOK DR
CAVE SPRINGS AR
72718-8806
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-2100
  • Fax:
Mailing address:
  • Phone: 479-936-0366
  • 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. SARAH MARIA GARDNER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 479-936-0366