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General NPI Number Information
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NPI Number | 1538709514
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Entity Type | Organization
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Legal Business Name | GARDNER ORTHODONTICS
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1246 E WALNUT LAWN ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4202
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Country | US
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Telephone | 417-719-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 1246 E WALNUT LAWN ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4202
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Country | US
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Telephone | 417-719-7862
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Fax |
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Authorized Official
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Title or Position | DMD - OWNER
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Name | THOMAS L. GARDNER
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Credential | DMD
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Telephone | 480-703-8198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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