Individual
RESA J GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
416 MAIN ST, WRAY, CO 80758-1725
(970) 332-4817
Mailing address
28960 US HIGHWAY 34, WRAY, CO 80758-9333
(719) 588-3036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00202209
CO
Other
Enumeration date
05/22/2014
Last updated
01/06/2015
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