Provider Demographics
NPI:1841286457
Name:GARDNER, DORY GAY (DDS)
Entity type:Individual
Prefix:
First Name:DORY
Middle Name:GAY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DORY
Other - Middle Name:GAY
Other - Last Name:GARDNER-BOEKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4486 ETTENMOOR LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-8741
Mailing Address - Country:US
Mailing Address - Phone:507-288-0177
Mailing Address - Fax:
Practice Address - Street 1:1751 HWY 52 N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1692
Practice Address - Country:US
Practice Address - Phone:507-282-9288
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice