Individual
MARY KATHERYN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18515 MANSEL AVE, REDONDO BEACH, CA 90278-4642
(310) 507-5756
Mailing address
18515 MANSEL AVE, REDONDO BEACH, CA 90278-4642
(310) 507-5756
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
68677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68677
RDA LICENSE
CA
Enumeration date
01/09/2014
Last updated
01/09/2014
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