Provider Demographics
NPI:1972626257
Name:GARDINSKY, GEORGE JOHN JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOHN
Last Name:GARDINSKY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:JOHN
Other - Last Name:GARDINSKY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:936 HIGHLAND AVE
Mailing Address - Street 2:P. O. BOX 1568
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-1750
Mailing Address - Country:US
Mailing Address - Phone:740-439-2950
Mailing Address - Fax:740-432-3470
Practice Address - Street 1:936 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-1750
Practice Address - Country:US
Practice Address - Phone:740-439-2950
Practice Address - Fax:740-432-3470
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist