Individual
MARK ANTHONY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7481 RIGHT FLANK RD STE 120, MECHANICSVILLE, VA 23116-3838
(804) 559-5416
Mailing address
11545 NUCKOLS RD STE A, GLEN ALLEN, VA 23059-5666
(804) 673-8061
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401415704
VA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
0401415704
VA
Other
Enumeration date
04/19/2017
Last updated
01/29/2024
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