Organization
CHAD M GARDNER DDS A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD MARTIN GARDNER DDS (OWNER/DENTIST)
(318) 281-5972
Entity
Organization
Contact information
Practice address
625 S WASHINGTON ST, BASTROP, LA 71220-5034
(318) 281-5972
(318) 281-9964
Mailing address
625 S WASHINGTON ST, BASTROP, LA 71220-5034
(318) 281-5972
(318) 281-9964
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5638
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1856380
—
LA
Enumeration date
11/16/2011
Last updated
11/16/2011
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