Organization
MEDVED D.D.S. - GARDNER D.D.S. PICKAWAY DENTAL GROUP LLC
Active
Other names
Pickaway General Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT W. GARDNER D.D.S. (PARTNER/MEMBER)
(614) 530-6558
Entity
Organization
Contact information
Practice address
1422 CIRCLEVILLE PLAZA DR, CIRCLEVILLE, OH 43113-2269
(614) 530-6558
(614) 262-2883
Mailing address
1422 CIRCLEVILLE PLAZA DR, CIRCLEVILLE, OH 43113-2269
(614) 530-6558
(614) 262-2883
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30020068
OH
1223G0001X
General Practice Dentistry
30020074
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0212577
—
OH
05
—
0978483
—
OH
Enumeration date
09/30/2009
Last updated
09/30/2009
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