Provider Demographics
NPI:1013119445
Name:GARDNER, ROBERTA ZEIGLER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ZEIGLER
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:887 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUIT 120
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3154
Mailing Address - Country:US
Mailing Address - Phone:843-881-0767
Mailing Address - Fax:843-881-4424
Practice Address - Street 1:887 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUIT 120
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3154
Practice Address - Country:US
Practice Address - Phone:843-881-0767
Practice Address - Fax:843-881-4424
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics