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General NPI Number Information
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NPI Number | 1003669862
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Entity Type | Individual
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Provider Name | BRYCE TANNER GARDNER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 218 E 800 S
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City | OREM
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State | UT
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Zip | 84058-5008
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Country | US
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Telephone | 520-850-5708
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Fax |
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Provider Business Mailing Address
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Address Line | 417 MILLCREEK RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-8814
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Country | US
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Telephone | 520-850-5708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13899356-9926
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License Number State | UT
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