Organization
MICHAEL B GARDNER PC
Active
Other names
All Smiles Kilgore
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GARDNER DDS (PRESIDENT)
(903) 984-1108
Entity
Organization
Contact information
Practice address
1806 BROADWAY BLVD, KILGORE, TX 75662-3520
(903) 984-1108
Mailing address
1806 BROADWAY BLVD, KILGORE, TX 75662-3520
(903) 984-1108
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
25450
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213519601
—
TX
Enumeration date
03/01/2012
Last updated
03/01/2012
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