Provider Demographics
NPI:1629293501
Name:GARDNER, YAN ZHOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:ZHOU
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YAN
Other - Middle Name:ZHOU
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8642 MAIN STREET
Mailing Address - Street 2:#220
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:503-582-8255
Mailing Address - Fax:503-582-9355
Practice Address - Street 1:8642 MAIN STREET
Practice Address - Street 2:#220
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-582-8255
Practice Address - Fax:503-582-9355
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist