Provider Demographics
NPI:1568681450
Name:GARDNER, S DONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:DONALD
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7138 HIGHLAND DR STE 213
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3781
Mailing Address - Country:US
Mailing Address - Phone:801-943-4423
Mailing Address - Fax:801-943-0458
Practice Address - Street 1:7138 HIGHLAND DR STE 213
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3781
Practice Address - Country:US
Practice Address - Phone:801-943-4423
Practice Address - Fax:801-943-0458
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT21471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics