Provider Demographics
NPI:1346358876
Name:GARDNER, DENNIS R (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:GARDNER
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 1:5311 MAIN STREET
Mailing Address - Street 2:PO BOX 129
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-0129
Mailing Address - Country:US
Mailing Address - Phone:931-486-2949
Mailing Address - Fax:931-486-2950
Practice Address - Street 1:5311 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-0129
Practice Address - Country:US
Practice Address - Phone:931-486-2949
Practice Address - Fax:931-486-2950
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4341731OtherBCBS