Provider Demographics
NPI:1235678301
Name:GILDNER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GILDNER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNY
Authorized Official - Last Name:GILDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-622-5173
Mailing Address - Street 1:602 E MAIN ST
Mailing Address - Street 2:E
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3729
Mailing Address - Country:US
Mailing Address - Phone:803-622-5173
Mailing Address - Fax:
Practice Address - Street 1:602 E MAIN ST
Practice Address - Street 2:E
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3729
Practice Address - Country:US
Practice Address - Phone:803-622-5173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty