Provider Demographics
NPI:1942619457
Name:GARDNER, PAMELA (DMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
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 1:5919 WILMETT RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2522
Mailing Address - Country:US
Mailing Address - Phone:301-443-8010
Mailing Address - Fax:301-480-4008
Practice Address - Street 1:NIH NIDCR DENTAL CLINIC
Practice Address - Street 2:10 CENTER DRIVE, 10/1N117
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-443-8010
Practice Address - Fax:301-480-4008
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ47511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice