Healthcare Provider Details

I. General information

NPI: 1528998366
Provider Name (Legal Business Name): JOEL P. GARDNER, DMD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E DIVISION ST
MOUNT VERNON WA
98274-4102
US

IV. Provider business mailing address

1210 E DIVISION ST
MOUNT VERNON WA
98274-4102
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-5464
  • Fax:
Mailing address:
  • Phone:
  • 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: ALEJANDRA SANDOVAL
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-336-5464