Provider Demographics
NPI:1417555855
Name:GARDNER SMILES PLLC
Entity Type:Organization
Organization Name:GARDNER SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGLAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-279-6190
Mailing Address - Street 1:356 TIMPANY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:356 TIMPANY BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-5200
Practice Address - Country:US
Practice Address - Phone:954-279-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental