Healthcare Provider Details

I. General information

NPI: 1538709514
Provider Name (Legal Business Name): GARDNER ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 E WALNUT LAWN ST
SPRINGFIELD MO
65804-4202
US

IV. Provider business mailing address

1246 E WALNUT LAWN ST
SPRINGFIELD MO
65804-4202
US

V. Phone/Fax

Practice location:
  • Phone: 417-719-7862
  • Fax:
Mailing address:
  • Phone: 417-719-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: THOMAS L. GARDNER
Title or Position: DMD - OWNER
Credential: DMD
Phone: 480-703-8198