Provider Demographics
NPI:1144229709
Name:GARD, EARL BRADEN IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:BRADEN
Last Name:GARD
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRADY
Other - Middle Name:
Other - Last Name:GARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1103 SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9433
Mailing Address - Country:US
Mailing Address - Phone:702-566-1278
Mailing Address - Fax:
Practice Address - Street 1:55 S VALLE VERDE DR
Practice Address - Street 2:STE. 250
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3433
Practice Address - Country:US
Practice Address - Phone:702-260-1890
Practice Address - Fax:702-260-7936
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5523122300000X
NV5736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist