Provider Demographics
NPI:1538493440
Name:GARDNER, MORGEN YOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:MORGEN
Middle Name:YOUNG
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 S 4TH ST
Mailing Address - Street 2:HEARTLAND DENTAL GROUP
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5013
Mailing Address - Country:US
Mailing Address - Phone:913-682-1000
Mailing Address - Fax:
Practice Address - Street 1:3507 S 4TH ST
Practice Address - Street 2:HEARTLAND DENTAL GROUP
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5013
Practice Address - Country:US
Practice Address - Phone:913-682-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00247181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice