Healthcare Provider Details

I. General information

NPI: 1518146364
Provider Name (Legal Business Name): GARDNER AND ANDERSON DENTAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 BROWNING WAY
ELKO NV
89801
US

IV. Provider business mailing address

1760 BROWNING WAY
ELKO NV
89801
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-6118
  • Fax: 775-738-2731
Mailing address:
  • Phone: 775-753-6118
  • Fax: 775-738-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS246C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4812T
License Number StateNV

VIII. Authorized Official

Name: SHERMAN DONALD GARDNER
Title or Position: OWNER
Credential: DMD
Phone: 775-753-6118