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General NPI Number Information
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NPI Number | 1144374109
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Entity Type | Individual
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Provider Name | JANETTE GAYLE GARDNER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 211 E LINCOLN ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-3633
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Country | US
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Telephone | 931-455-2595
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Fax | 931-455-4728
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Provider Business Mailing Address
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Address Line | 4171 EASTBROOK RD
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City | ESTILL SPRINGS
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State | TN
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Zip | 37330-3613
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Country | US
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Telephone | 931-962-9084
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8525
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License Number State | TN
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