Provider Demographics
NPI:1265481774
Name:GARDIN, RONALD DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUANE
Last Name:GARDIN
Suffix:
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 1:390 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2731
Mailing Address - Country:US
Mailing Address - Phone:231-723-3112
Mailing Address - Fax:231-723-6790
Practice Address - Street 1:390 RIVER ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2731
Practice Address - Country:US
Practice Address - Phone:231-723-3112
Practice Address - Fax:231-723-6790
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1104201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice