Individual
THERESA GARDOCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTIS
Contact information
Practice address
600 PLEASANT OAK DR, OREGON, WI 53575-3648
(608) 835-3388
(608) 835-3386
Mailing address
600 PLEASANT OAK DR, OREGON, WI 53575-3648
(608) 835-3388
(608) 835-3386
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3054
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33458500
—
WI
Enumeration date
09/27/2006
Last updated
01/26/2009
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