Provider Demographics
NPI:1033463328
Name:GAERTNER, TOMMY (DMD)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:GAERTNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 S UNIVERSITY DR
Mailing Address - Street 2:MAILBOX#10203
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1453
Mailing Address - Country:US
Mailing Address - Phone:954-593-4448
Mailing Address - Fax:
Practice Address - Street 1:400 W 41ST ST
Practice Address - Street 2:STE 500
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:954-593-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist