Provider Demographics
NPI:1144374109
Name:GARDNER, JANETTE GAYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:GAYLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 EASTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3613
Mailing Address - Country:US
Mailing Address - Phone:931-962-9084
Mailing Address - Fax:
Practice Address - Street 1:211 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3633
Practice Address - Country:US
Practice Address - Phone:931-455-2595
Practice Address - Fax:931-455-4728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice