MEDICARE: DR. EARL BRADEN GARD IV D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D5523	AZ
2	122300000X	Dentist	5736	NV

General Provider Information

NPI Number	:	1144229709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EARL BRADEN GARD IV D.D.S.

Provider Business Mailing Address
First Line	:	1103 SAN GABRIEL AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-9433
Country	:	US
Telephone Number	:	702-566-1278
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S VALLE VERDE DR
Second Line	:	STE. 250
City	:	HENDERSON
State	:	NV
Zip	:	89012-3433
Country	:	US
Telephone Number	:	702-260-1890
Fax Number	:	702-260-7936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	04/24/2016

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