Michael Raymond Gardner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8951 Issued in MN

Practice address

1901 6TH St SW
Willmar, MN 56201-5104

Phone

(320) 231-1290

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699798371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 6TH ST SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015104",
            "telephone_number": "320-231-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 6TH ST SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015104",
            "telephone_number": "320-231-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "MICHAEL",
        "middle_name": "RAYMOND",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Fugere Jr., LADC
• Anna R. Fuglestad, M.D.
• Daniel S Fuglestad, MD
• Brooke Joann Gabrielson, BSN, RN
• Veronica Garcia
• Rebecca Gardner, LPCC
• Sandra K Gardner, RD, LD
• Abi Gasca
• Emily Gass
• Alexander Gawarecki, LPCC

• General Practice Dentistry in Willmar, MN
• Providers in Willmar, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.