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General NPI Number Information
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NPI Number | 1659684983
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Entity Type | Organization
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Legal Business Name | DR. GARDNER D.D.S. & ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 112 JEFFERSON AVE SUITE 002
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City | COLUMBUS
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State | OH
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Zip | 43215-1861
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Country | US
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Telephone | 614-262-8180
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Fax | 614-262-2883
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Provider Business Mailing Address
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Address Line | 112 JEFFERSON AVE SUITE 002
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City | COLUMBUS
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State | OH
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Zip | 43215-1861
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Country | US
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Telephone | 614-262-8180
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Fax | 614-262-2883
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT W. GARDNER
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Credential | D.D.S.
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Telephone | 614-262-8180
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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 | 30020068
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License Number State | OH
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