Gardner Pediatric Dentistry LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2012019137 Issued in MO

Legal business name

GARDNER PEDIATRIC DENTISTRY LLC

Doing business as

Expedition Pediatric Dentistry & Orthodontics

Practice address

1250 E Walnut Lawn St
Springfield, MO 65804-4202

Phone

(417) 396-7318

NPI assigned

Aug 19, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Nathaniel Gardner, D.M.D.NPI 1992050132

Title

Owner

Phone

(417) 719-7862

Specialties & licenses 1

Addresses

Other names 1

• Expedition Pediatric Dentistry & Orthodontics Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jesse Nathaniel Gardner, D.M.D.

  • Dentist
  • Springfield, MO
  • NPI 1992050132
  NPD Authorized official
• Thomas Levier Gardner, D.M.D

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Springfield, MO
  • NPI 1063811644
  NPD (past)
• Raechelle Hayter, DDS

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1932511060
  NPD (past)

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1437558137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 E WALNUT LAWN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044202",
            "telephone_number": "417-396-7318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E WALNUT LAWN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044202",
            "telephone_number": "417-396-7318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "716 W Mount Vernon St",
            "address_purpose": "LOCATION",
            "city": "Nixa",
            "state": "MO",
            "postal_code": "657149682",
            "country_code": "US",
            "telephone_number": "417-719-7862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "764 US Highway 60 E",
            "address_purpose": "LOCATION",
            "city": "Republic",
            "state": "MO",
            "postal_code": "657381524",
            "country_code": "US",
            "telephone_number": "417-719-7862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GARDNER PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "NATHANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-719-7862",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2012019137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Expedition Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samir S. Garcia, M.D.
• Silvia Isabel Garcia, M.D.
• Stephen Eugene Garcia, M.D.
• Catelynn Raye Garde, DDS
• Gardner Orthodontics
• Jemika Gardner, LMSW
• Jesse Nathaniel Gardner, D.M.D.
• Thomas Levier Gardner, D.M.D
• Brady Robert Garmon
• Christopher Garner, PA

• Pediatric Dentistry in Springfield, MO
• Providers in Springfield, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; 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.