Healthcare Provider Details

I. General information

NPI: 1679129878
Provider Name (Legal Business Name): JAMES EDWARD GARDNER III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14381 SPRING HILL DR
SPRING HILL FL
34609-8199
US

IV. Provider business mailing address

5001 BRIDGE ST APT 2602
TAMPA FL
33611-3252
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: