Provider Demographics
NPI:1184884009
Name:DONALD G GARDNER DDS, INC.
Entity type:Organization
Organization Name:DONALD G GARDNER DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-491-4545
Mailing Address - Street 1:4915 S MAIN ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4601
Mailing Address - Country:US
Mailing Address - Phone:281-491-4545
Mailing Address - Fax:281-491-7134
Practice Address - Street 1:4915 S MAIN ST
Practice Address - Street 2:SUITE 118
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4601
Practice Address - Country:US
Practice Address - Phone:281-491-4545
Practice Address - Fax:281-491-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX110371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1108623-04Medicaid
TX1544389-01Medicaid