Provider Demographics
NPI:1093809253
Name:CHILDRENS DENTAL CARE PC
Entity Type:Organization
Organization Name:CHILDRENS DENTAL CARE PC
Other - Org Name:MARK W GARDNER DDS MS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREATMENT COORDINATOR BUSINESS OFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-934-6166
Mailing Address - Street 1:1239 STATE RD 229
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-6804
Mailing Address - Country:US
Mailing Address - Phone:812-934-6166
Mailing Address - Fax:812-933-0607
Practice Address - Street 1:1239 STATE RD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-6804
Practice Address - Country:US
Practice Address - Phone:812-934-6166
Practice Address - Fax:812-933-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty