MEDICARE: ROBERT W. GARDNER, D.D.S. INC.

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	1223G0001X	General Practice Dentistry	30020068	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548536832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT W. GARDNER, D.D.S. INC.

Provider Business Mailing Address
First Line	:	4490 INDIANOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2244
Country	:	US
Telephone Number	:	614-262-8180
Fax Number	:	614-262-2883

Provider Business Practice Location Address
First Line	:	4490 INDIANOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2244
Country	:	US
Telephone Number	:	614-262-8180
Fax Number	:	614-262-2883

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NATALIE SMITH
Credential	:
Telephone Number	:	614-262-8180

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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