Provider Demographics
NPI:1114042793
Name:GARDENHIRE, TOM M JR (DDS)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:M
Last Name:GARDENHIRE
Suffix:JR
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 1:6101 SHALLOWFORD RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6101 SHALLOWFORD RD
Practice Address - Street 2:STE. 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7802
Practice Address - Country:US
Practice Address - Phone:423-892-4477
Practice Address - Fax:423-892-4229
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice