Michael Terry Gardner, DMD
Individual provider Active NPI Oral and Maxillofacial Pathology Dentistry · San Antonio, TX
NPI 1467567792 · NPPES record last updated Mar 8, 2021
Key facts
- NPI
- 1467567792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Pathology Dentistry 1223P0106X
- License
- 4375 (AL)
- Practice address
- 1100 Wilford Hall Loop BLDG 4554
San Antonio, TX 78236-5638 - Phone
- (210) 916-6491
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 4375 | AL | Yes |
Addresses
Primary practice location
1100 Wilford Hall Loop BLDG 4554
San Antonio, TX 78236-5638
Mailing address
1100 Wilford Hall Loop BLDG 4554
San Antonio, TX 78236-5638
Phone (210) 916-6491
Other practice location 1
3551 Roger Brooke Dr
San Antonio, TX 78234-4504
Phone (210) 916-6491
Other providers in San Antonio, TX
- James Francis Gardner III
- Jennifer Gardner
- Kelly Ann Gardner
- Kenneth L Gardner
- Michael Owen Gardner
- Sean Cavendish Gardner
- Sheri Gardner
- Sherra Gardner
- Sylvia Brittany Gardner
- Troy Allen Gardner
All providers in San Antonio, TX · Oral and Maxillofacial Pathology Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2021. 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.