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General NPI Number Information
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NPI Number | 1891955050
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Entity Type | Organization
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Legal Business Name | JOHN A GARDNER, DDS, PC
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1316 OLD 63 S STE. 201
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City | COLUMBIA
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State | MO
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Zip | 65201-6092
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Country | US
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Telephone | 573-443-2544
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Fax | 573-815-0840
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Provider Business Mailing Address
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Address Line | 1316 OLD 63 S STE. 201
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City | COLUMBIA
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State | MO
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Zip | 65201-6092
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Country | US
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Telephone | 573-443-2544
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Fax | 573-815-0840
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/PRESIDENT
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Name | DR. JOHN ALLEN GARDNER
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Credential | DDS
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Telephone | 573-443-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10937
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License Number State | MO
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