Provider Demographics
NPI:1790766129
Name:GARDNER & GARCIA, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:GARDNER & GARCIA, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-543-1938
Mailing Address - Street 1:1235 S GERTRUDA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5125
Mailing Address - Country:US
Mailing Address - Phone:310-543-1938
Mailing Address - Fax:310-543-9796
Practice Address - Street 1:1235 S GERTRUDA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5125
Practice Address - Country:US
Practice Address - Phone:310-543-1938
Practice Address - Fax:310-543-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty