Organization
GARDNER DENTAL LLC
Active
Other names
Winslow Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT JACOB GARDNER DDS (OWNER)
(614) 254-3384
Entity
Organization
Contact information
Practice address
321 W SECOND ST, WINSLOW, AZ 86047-3406
(928) 289-4441
Mailing address
321 W SECOND ST, WINSLOW, AZ 86047-3406
(928) 289-4441
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D09050
AZ
Other
Enumeration date
10/13/2016
Last updated
10/13/2016
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