Provider Demographics
NPI:1679626881
Name:GARDNER, WENDELL KERRIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:KERRIN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 W WARD RD STE 306
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3057
Mailing Address - Country:US
Mailing Address - Phone:410-257-5333
Mailing Address - Fax:
Practice Address - Street 1:3150 W WARD RD STE 306
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3057
Practice Address - Country:US
Practice Address - Phone:410-257-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000080211223S0112X
MD140291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery