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General NPI Number Information
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NPI Number | 1114443207
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Entity Type | Organization
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Legal Business Name | TIMOTHY E. GARDNER, D.D.S., LTD., L.L.P.
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2210 N FRAZIER ST
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City | CONROE
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State | TX
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Zip | 77303-1780
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Country | US
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Telephone | 936-539-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 N FRAZIER ST
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City | CONROE
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State | TX
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Zip | 77303-1780
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Country | US
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Telephone | 936-539-3636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY GARDNER
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Credential | DDS
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Telephone | 936-539-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16499
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License Number State | TX
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