Provider Demographics
NPI:1578694857
Name:GARDNER, DONALD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
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 1:432 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4730
Mailing Address - Country:US
Mailing Address - Phone:203-748-2606
Mailing Address - Fax:203-790-5344
Practice Address - Street 1:432 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4730
Practice Address - Country:US
Practice Address - Phone:203-748-2606
Practice Address - Fax:203-790-5344
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist