Individual
NATHAN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2065 12TH AVE RD, NAMPA, ID 83686-6311
(208) 466-3239
Mailing address
136 ARBOR CT, OMAHA, NE 68108-1725
(208) 501-3901
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-5624
ID
Other
Enumeration date
04/02/2024
Last updated
05/30/2024
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