Active NPI
Brandon Michael Gardner, DDS
- General Practice Dentistry
- Boerne, TX
National Provider Identifier
1093003964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27887
- Practice address
- 134 Menger Springs Ste 1270
Boerne, TX 78006 - Phone
- (830) 267-8782
- Fax
- (830) 331-9177
- NPI assigned
- Jul 13, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | ETN5 | TX | |
| General Practice Dentistry | 1223G0001X | 27887 | TX | Primary |
Addresses
Primary practice location
134 Menger Springs Ste 1270
Boerne, TX 78006
Mailing address
134 Menger Springs Ste 1270
Boerne, TX 78006
Phone (830) 267-8782
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 |
|---|---|---|---|
| 27887 | TX | MD | General Practice Dentistry |
| ETN5 | TX | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506988800000",
"number": "1093003964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 MENGER SPRINGS STE 1270",
"city": "BOERNE",
"state": "TX",
"postal_code": "78006",
"telephone_number": "830-267-8782",
"fax_number": "830-331-9177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 MENGER SPRINGS STE 1270",
"city": "BOERNE",
"state": "TX",
"postal_code": "78006",
"telephone_number": "830-267-8782",
"fax_number": "830-331-9177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "BRANDON",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-13",
"last_updated": "2017-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "ETN5",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boerne, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.