Organization
GARDNER PEDIATRIC DENTISTRY LLC
Active
Other names
Expedition Pediatric Dentistry & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE NATHANIEL GARDNER D.M.D. (OWNER)
(417) 719-7862
Entity
Organization
Contact information
Practice address
1250 E WALNUT LAWN ST, SPRINGFIELD, MO 65804-4202
(417) 396-7318
Mailing address
1250 E WALNUT LAWN ST, SPRINGFIELD, MO 65804-4202
(417) 396-7318
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2012019137
MO
Other
Enumeration date
08/19/2014
Last updated
12/11/2024
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