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General NPI Number Information
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NPI Number | 1316911746
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Entity Type | Individual
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Provider Name | GARY DON GARDNER DDS
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 21ST STREET BLDG 2441
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5369
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Country | US
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Telephone | 270-798-8614
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Fax | 270-798-8633
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Provider Business Mailing Address
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Address Line | 21ST STREET BLDG 2441
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5369
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Country | US
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Telephone | 270-798-8614
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Fax | 270-798-8633
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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 | 3156
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3156
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License Number State | AR
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