Provider Demographics
NPI:1750640108
Name:JAMES T. GARDINER FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:JAMES T. GARDINER FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-383-0377
Mailing Address - Street 1:121 E. 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-2413
Mailing Address - Country:US
Mailing Address - Phone:256-383-0377
Mailing Address - Fax:256-383-0745
Practice Address - Street 1:121 E. 6TH ST.
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-2413
Practice Address - Country:US
Practice Address - Phone:256-383-0377
Practice Address - Fax:256-383-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009207250Medicaid