Healthcare Provider Details

I. General information

NPI: 1447898481
Provider Name (Legal Business Name): GE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 N GILBERT RD STE 104
MESA AZ
85203-5836
US

IV. Provider business mailing address

3848 E MALLORY ST
MESA AZ
85215-1714
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-7200
  • Fax:
Mailing address:
  • Phone: 480-238-7369
  • 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. QUINTON W GARDNER
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 480-649-7200