Provider Demographics
NPI:1730412461
Name:GARDNER FAMILY HEALTH NETWORK
Entity type:Organization
Organization Name:GARDNER FAMILY HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGHOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-918-2667
Mailing Address - Street 1:7526 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5826
Mailing Address - Country:US
Mailing Address - Phone:408-848-9436
Mailing Address - Fax:408-848-9468
Practice Address - Street 1:55 E JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4007
Practice Address - Country:US
Practice Address - Phone:408-918-2626
Practice Address - Fax:408-280-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58660261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental