Provider Demographics
NPI:1083839302
Name:GARDNER, ROBERT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:GARDNER
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 1:9878 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2101
Mailing Address - Country:US
Mailing Address - Phone:303-978-1316
Mailing Address - Fax:303-978-1035
Practice Address - Street 1:9878 W BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2101
Practice Address - Country:US
Practice Address - Phone:303-978-1316
Practice Address - Fax:303-978-1035
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1045301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics