Provider Demographics
NPI:1114443207
Name:TIMOTHY E. GARDNER, D.D.S., LTD., L.L.P.
Entity Type:Organization
Organization Name:TIMOTHY E. GARDNER, D.D.S., LTD., L.L.P.
Other - Org Name:CONROE COMPREHENSIVE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-539-3636
Mailing Address - Street 1:2210 N FRAZIER ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-1780
Mailing Address - Country:US
Mailing Address - Phone:936-539-3636
Mailing Address - Fax:
Practice Address - Street 1:2210 N FRAZIER ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1780
Practice Address - Country:US
Practice Address - Phone:936-539-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty