Individual
DR. BRENT JACOB GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
321 W SECOND ST, WINSLOW, AZ 86047-3406
(614) 254-3384
Mailing address
321 W SECOND ST, WINSLOW, AZ 86047-3406
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009054
AZ
Other
Enumeration date
08/04/2014
Last updated
08/04/2014
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