Individual provider Active NPI

William Brian Gardiner, D.D.S.

  • General Practice Dentistry
  • Maumee, OH
National Provider Identifier
1295704500
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
290160204 Issued in MI
Practice address
3210 Briarfield Blvd
Maumee, OH 43537-9501
Phone
(419) 866-2400
NPI assigned
Mar 17, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30.022704 OH
General Practice Dentistry 1223G0001X 290160204 MI Primary

Addresses

Primary practice location

3210 Briarfield Blvd
Maumee, OH 43537-9501

Mailing address

3210 Briarfield Blvd
Maumee, OH 43537-9501
Phone (419) 866-2400

Other practice location 1

811 W Grand River Ave
Portland, MI 48875-1126
Phone (517) 647-6205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160114001914 OH Order and Referring Only - DentistPractitioner - Dentist 9335442961

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
290160204MIMDGeneral Practice Dentistry
30.022704OHMDGeneral Practice Dentistry

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1295704500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 BRIARFIELD BLVD",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379501",
            "telephone_number": "419-866-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 BRIARFIELD BLVD",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379501",
            "telephone_number": "419-866-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 W Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "MI",
            "postal_code": "488751126",
            "country_code": "US",
            "telephone_number": "517-647-6205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDINER",
        "first_name": "WILLIAM",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.022704",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "290160204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

Verify at the official NPI Registry.