Provider Demographics
NPI:1093928798
Name:GARDNER, WILLIAM LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEO
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 1:2241 CENTRAL AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4430
Mailing Address - Country:US
Mailing Address - Phone:510-865-4400
Mailing Address - Fax:510-865-4417
Practice Address - Street 1:2241 CENTRAL AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4430
Practice Address - Country:US
Practice Address - Phone:510-865-4400
Practice Address - Fax:510-865-4417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice