MEDICARE: COLE GARDNER DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DR61681277	WA

General Provider Information

NPI Number	:	1396445235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE GARDNER DDS

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST BOX 357134
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:	509-840-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-3720
Country	:	US
Telephone Number	:	509-840-3032
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	07/01/2025

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Directions to “ COLE GARDNER DDS” Practice Location

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