Individual
MARY STEPHANY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRDH
Contact information
Practice address
12351 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5251
(239) 910-5553
Mailing address
50 EBENEZER CHURCH RD APT 13, STAFFORD, VA 22556-3881
(239) 910-5553
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402207699
VA
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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