Provider Demographics
NPI:1053330399
Name:GARDINER, BART TRAVIS (DDS)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:TRAVIS
Last Name:GARDINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3688 EAST CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005
Mailing Address - Country:US
Mailing Address - Phone:801-789-4414
Mailing Address - Fax:801-789-4415
Practice Address - Street 1:3688 EAST CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005
Practice Address - Country:US
Practice Address - Phone:801-789-4414
Practice Address - Fax:801-789-4415
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT239031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice