Active NPI
Kevin Gardner
- Dentist
- Everett, WA
National Provider Identifier
1043908510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DENT.DE.61435584
- Practice address
- 111 SE Everett Mall Way BLDG D
Everett, WA 98208-3208 - Phone
- (425) 667-3333
- NPI assigned
- Apr 24, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DENT.DE.61435584 | WA | Primary |
Addresses
Primary practice location
111 SE Everett Mall Way BLDG D
Everett, WA 98208-3208
Mailing address
12483 Persons Rd
Bow, WA 98232-7202
Phone (360) 391-7455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DENT.DE.61435584 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682294400000",
"number": "1043908510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12483 PERSONS RD",
"city": "BOW",
"state": "WA",
"postal_code": "982327202",
"telephone_number": "360-391-7455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 SE EVERETT MALL WAY BLDG D",
"city": "EVERETT",
"state": "WA",
"postal_code": "982083208",
"telephone_number": "425-667-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "KEVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-24",
"last_updated": "2023-04-24",
"certification_date": "2023-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DENT.DE.61435584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.