Provider Demographics
NPI:1639327166
Name:GARDNER, PATRICIA ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1367
Mailing Address - Country:US
Mailing Address - Phone:908-730-8988
Mailing Address - Fax:
Practice Address - Street 1:75 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:NJ
Practice Address - Zip Code:08802-1367
Practice Address - Country:US
Practice Address - Phone:908-730-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI-02111300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist