Provider Demographics
NPI:1982032579
Name:GARDNER & GARDNER DDS, INC
Entity Type:Organization
Organization Name:GARDNER & GARDNER DDS, INC
Other - Org Name:SANTA ANA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-800-7195
Mailing Address - Street 1:1617 E 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6385
Mailing Address - Country:US
Mailing Address - Phone:714-617-5048
Mailing Address - Fax:714-617-5041
Practice Address - Street 1:1617 E 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6385
Practice Address - Country:US
Practice Address - Phone:714-617-5048
Practice Address - Fax:714-617-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty