Individual
JONATHAN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
622 SOUTH MAIN STREET, MULLINS, SC 29574
(843) 464-6162
Mailing address
PO BOX 54, AYNOR, SC 29511
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10520
SC
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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