MEDICARE: DR. S DONALD GARDNER D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2147	UT

General Provider Information

NPI Number	:	1568681450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. S DONALD GARDNER D.M.D.

Provider Business Mailing Address
First Line	:	7138 HIGHLAND DR STE 213
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3781
Country	:	US
Telephone Number	:	801-943-4423
Fax Number	:	801-943-0458

Provider Business Practice Location Address
First Line	:	7138 HIGHLAND DR STE 213
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3781
Country	:	US
Telephone Number	:	801-943-4423
Fax Number	:	801-943-0458

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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