Provider Demographics
NPI:1598816365
Name:GARDINER, MITCHELL JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JEFFREY
Last Name:GARDINER
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 1:59 AVENUE AT THE COMMON
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-741-5533
Mailing Address - Fax:732-741-6064
Practice Address - Street 1:59 AVENUE AT THE COMMON
Practice Address - Street 2:SUITE 205
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-741-5533
Practice Address - Fax:732-741-6064
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ124551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice