Provider Demographics
NPI:1902942923
Name:GARDNER, SHAUN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:PATRICK
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 S VINEYARD STE 150
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6892
Mailing Address - Country:US
Mailing Address - Phone:480-345-7668
Mailing Address - Fax:480-413-1408
Practice Address - Street 1:2045 S VINEYARD STE 150
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6892
Practice Address - Country:US
Practice Address - Phone:480-345-7668
Practice Address - Fax:480-413-1408
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice