Provider Demographics
NPI:1417173774
Name:GARDNER, HUGH K JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:K
Last Name:GARDNER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HUGH
Other - Middle Name:K
Other - Last Name:GARDNER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3618 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4106
Mailing Address - Country:US
Mailing Address - Phone:502-447-7646
Mailing Address - Fax:502-448-6311
Practice Address - Street 1:3618 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4106
Practice Address - Country:US
Practice Address - Phone:502-447-7646
Practice Address - Fax:502-448-6311
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y219OtherFEDERAL PROVIDER