Jonathan Gardner, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10520 Issued in SC

Practice address

622 South Main Street
Mullins, SC 29574

Phone

(843) 464-6162

NPI assigned

Jun 26, 2023

Last updated

Jun 26, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blevins Dentistry, PA

  • Dental Clinic/Center
  • Mullins, SC
  • NPI 1205619418
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1053097964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54",
            "city": "AYNOR",
            "state": "SC",
            "postal_code": "29511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 SOUTH MAIN STREET",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "29574",
            "telephone_number": "843-464-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JONATHAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasminn Foxworth
• Michael Bruce Frederickson, R.PH.
• Felix Fredrick
• Sandra Gainey, BACHELORS
• Glenn Ross Gangi, MD
• James S Garner IV, MD
• Amy Paige Gerald, RN
• Elisa L Gibbs
• Alicia B Gilbert, RN
• Christina Godbolt

• General Practice Dentistry in Mullins, SC
• Providers in Mullins, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.

Verify at the official NPI Registry.