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Organization
GARY W BARDONNER, DDS, INC
Active
Organization
GARY W BARDONNER, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY W BARDONNER D.D.S. (PRESIDENT)
(317) 462-2656
Entity
Organization
Contact information
Practice address
940 N STATE ST, GREENFIELD, IN 46140-1202
(317) 462-2656
Mailing address
940 N STATE ST, GREENFIELD, IN 46140-1202
(317) 462-2656
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007317
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12007317
STATE DENTAL LICENSE
IN
01
—
12009221
STATE DENTAL LICENSE
IN
Enumeration date
03/14/2007
Last updated
08/22/2020
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