Organization
WILLIAM B. GARDNER, D.M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI FOUNTAIN GARDNER RDH (DENTAL HYGIENIST)
(706) 647-7914
Entity
Organization
Contact information
Practice address
507 W GORDON ST, THOMASTON, GA 30286-3424
(706) 647-7914
(706) 647-4543
Mailing address
507 W GORDON ST, THOMASTON, GA 30286-3424
(706) 647-7914
(706) 647-4543
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11133
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00545124A
—
GA
01
—
100417
AVESIS
GA
01
—
9181304
DORAL
GA
Enumeration date
01/23/2009
Last updated
01/23/2009
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