Provider Demographics
NPI:1992180319
Name:JEFFREY J. GARDNER,DMD,PA
Entity Type:Organization
Organization Name:JEFFREY J. GARDNER,DMD,PA
Other - Org Name:SMILING OAK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-884-0335
Mailing Address - Street 1:1077 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3155
Mailing Address - Country:US
Mailing Address - Phone:843-884-0335
Mailing Address - Fax:843-884-6399
Practice Address - Street 1:1077 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3155
Practice Address - Country:US
Practice Address - Phone:843-884-0335
Practice Address - Fax:843-884-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty