Provider Demographics
NPI:1932376563
Name:DR. S. DANIEL GARDNER DMD, LLC
Entity type:Organization
Organization Name:DR. S. DANIEL GARDNER DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-795-5565
Mailing Address - Street 1:849 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-5076
Mailing Address - Country:US
Mailing Address - Phone:843-795-5565
Mailing Address - Fax:843-795-2329
Practice Address - Street 1:849 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-5076
Practice Address - Country:US
Practice Address - Phone:843-795-5565
Practice Address - Fax:843-795-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3668261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental