Healthcare Provider Details

I. General information

NPI: 1861784449
Provider Name (Legal Business Name): PRESTON ALDEN GARDNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 VENETIAN CT STE 1
NAPLES FL
34109-8728
US

IV. Provider business mailing address

2235 VENETIAN CT STE 1
NAPLES FL
34109-8728
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-9337
  • Fax: 239-596-9466
Mailing address:
  • Phone: 239-596-9337
  • Fax: 239-596-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number02005587A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberOS21708
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101019137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: