Organization
GARDNER DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWIGHT K. STOWELL JR. D.M.D. (OWNER)
(978) 249-8545
Entity
Organization
Contact information
Practice address
49 CROSS STREET EXT, GARDNER, MA 01440-2209
(978) 632-5659
(978) 632-5713
Mailing address
49 CROSS STREET EXT, GARDNER, MA 01440-2209
(978) 632-5659
(978) 632-5713
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12736
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1250
DELTA DENTAL
MA
01
—
36564
UNITED CONCORDIA
MA
05
—
9794671
—
MA
01
—
X12692
BLUECROSS BLUESHIELD OF MA
MA
Enumeration date
03/16/2007
Last updated
06/17/2008
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