Jesse Nathaniel Gardner, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

2012019137 Issued in MO

Practice address

1250 E Walnut Lawn St
Springfield, MO 65804-4202

Phone

(417) 719-7862

Fax

(417) 719-7861

NPI assigned

Jul 13, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gardner Pediatric Dentistry LLC

  • Pediatric Dentistry
  • Springfield, MO
  • NPI 1437558137
  NPD Authorized official

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426118400000",
    "number": "1992050132",
    "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": "417-719-7862",
            "fax_number": "417-719-7861"
        },
        {
            "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": "417-719-7862",
            "fax_number": "417-719-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JESSE",
        "middle_name": "NATHANIEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-13",
        "last_updated": "2015-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2012019137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Eugene Garcia, M.D.
• Catelynn Raye Garde, DDS
• Gardner Orthodontics
• Gardner Pediatric Dentistry LLC
• Jemika Gardner, LMSW
• Thomas Levier Gardner, D.M.D
• Brady Robert Garmon
• Christopher Garner, PA
• Emily Garner
• John Brian Garner, MD

• Dentist in Springfield, MO
• Providers in Springfield, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; 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.