Provider Demographics
NPI:1114089299
Name:GARDNER, EDWARD D JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:GARDNER
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 1:8133 FOREST HILL AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-272-2010
Mailing Address - Fax:804-330-4703
Practice Address - Street 1:8133 FOREST HILL AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-272-2010
Practice Address - Fax:804-330-4703
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180686OtherWELLPOINT
VA180686OtherANTHEM
VA401660OtherUNITED CONCORDIA
VA180686OtherBCBS