Provider Demographics
NPI:1861546558
Name:GARDNER, DONALD GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GEORGE
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 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-524-8341
Mailing Address - Fax:713-520-6772
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 380
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-524-8341
Practice Address - Fax:713-520-6772
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13391Medicare UPIN