Provider Demographics
NPI:1114012259
Name:DANIEL G. GARDINER DDS INC.
Entity Type:Organization
Organization Name:DANIEL G. GARDINER DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-946-6170
Mailing Address - Street 1:840-A W. NINTH ST.
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4545
Mailing Address - Country:US
Mailing Address - Phone:909-946-6170
Mailing Address - Fax:909-946-5608
Practice Address - Street 1:840-A W. NINTH ST.
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4545
Practice Address - Country:US
Practice Address - Phone:909-946-6170
Practice Address - Fax:909-946-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty