Gerald P Gardner, DDS
Individual provider Active NPI Dentist · Brookfield, IL
NPI 1205920436 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205920436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- Practice address
- 9224 Broadway
Brookfield, IL 60513 - Phone
- (708) 485-0340
- Fax
- (708) 485-0631
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019021033 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Advancements in Dental Care | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Yes |
Addresses
Primary practice location
9224 Broadway
Brookfield, IL 60513
Mailing address
9224 Broadway
Brookfield, IL 60513
Phone (708) 485-0340
Other providers in Brookfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.