# GARY W BARDONNER, DDS, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285768259
- **Authorized official:** DR. GARY W BARDONNER D.D.S. (PRESIDENT)
- **Authorized official phone:** (317) 462-2656

## Contact information

- **Practice address:** 940 N STATE ST, GREENFIELD, IN 46140-1202
- **Practice address phone:** (317) 462-2656
- **Mailing address:** 940 N STATE ST, GREENFIELD, IN 46140-1202
- **Mailing address phone:** (317) 462-2656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007317 | IN | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12007317 | STATE DENTAL LICENSE | IN |
| 01 | — | 12009221 | STATE DENTAL LICENSE | IN |