Provider Demographics
NPI:1073946281
Name:GARDINER, DANIEL GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GEORGE
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 1:840 W 9TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4583
Mailing Address - Country:US
Mailing Address - Phone:909-946-6170
Mailing Address - Fax:909-946-5608
Practice Address - Street 1:840 W 9TH ST
Practice Address - Street 2:STE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4583
Practice Address - Country:US
Practice Address - Phone:909-946-6170
Practice Address - Fax:909-946-5608
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics