Brent Jacob Gardner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D009054 Issued in AZ

Practice address

321 W Second St
Winslow, AZ 86047-3406

Phone

(614) 254-3384

NPI assigned

Aug 4, 2014

Last updated

Aug 4, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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 AZ

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

Practice roles

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.

• Gardner Dental LLC

  dba Winslow Dental

  • Dental Clinic/Center
  • Winslow, AZ
  • NPI 1538619515
  NPD (past) Authorized official
• Winslow Dental

  • Dental Clinic/Center
  • Winslow, AZ
  • NPI 1265459051
  NPD (past)

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407110400000",
    "number": "1720497779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 W SECOND ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 W SECOND ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473406",
            "telephone_number": "614-254-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "BRENT",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2014-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D009054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Gable, RN
• Janelle Dawn Gaddis, NP-C
• Rosa Idalia Gallegos, CPHT
• Gardner Dental LLC (Winslow Dental)
• Benjamin J Gardner, D.D.S.
• Merih Estifanos Gebrezgiabher
• Gentle Soles, Inc.
• Juliette Gonzalez
• Teresa Gonzalez, M.A.
• Kathryn S Good, RN

• General Practice Dentistry in Winslow, AZ
• Providers in Winslow, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; 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.