| Michael B Gardner Pc | |
|
1806 Broadway Blvd Kilgore TX 75662-3520 | |
| (903) 984-1108 | |
| Not Available |
| Full Name | Michael B Gardner Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1806 Broadway Blvd, Kilgore, Texas |
| Authorized Official Name and Position | Michael Gardner (PRESIDENT) |
| Authorized Official Contact | 9039841108 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael B Gardner Pc 1806 Broadway Blvd Kilgore TX 75662-3520 Ph: (903) 984-1108 | Michael B Gardner Pc 1806 Broadway Blvd Kilgore TX 75662-3520 Ph: (903) 984-1108 |
| NPI Number | 1912271420 |
|---|---|
| Provider Enumeration Date | 03/01/2012 |
| Last Update Date | 03/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912271420 | NPI | - | NPPES |
| 213519601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 25450 (Texas) | Primary |
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