MEDICARE: JOEL P. GARDNER, DMD, PS

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

General Provider Information

NPI Number	:	1922959105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL P. GARDNER, DMD, PS

Provider Business Mailing Address
First Line	:	651 SE MAYLOR ST
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-5413
Country	:	US
Telephone Number	:	360-336-5464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 E DIVISION ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4102
Country	:	US
Telephone Number	:	360-336-5464
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOEL P GARDNER
Credential	:
Telephone Number	:	360-336-5464

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	03/20/2026

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