Chad M Gardner Dds A Professional Dental Corporation | |
625 S Washington St Bastrop LA 71220-5034 | |
(318) 281-5972 | |
(318) 281-9964 |
Full Name | Chad M Gardner Dds A Professional Dental Corporation |
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Speciality | Dentist |
Location | 625 S Washington St, Bastrop, Louisiana |
Authorized Official Name and Position | Chad Martin Gardner (OWNER/DENTIST) |
Authorized Official Contact | 3182815972 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Chad M Gardner Dds A Professional Dental Corporation 625 S Washington St Bastrop LA 71220-5034 Ph: (318) 281-5972 | Chad M Gardner Dds A Professional Dental Corporation 625 S Washington St Bastrop LA 71220-5034 Ph: (318) 281-5972 |
NPI Number | 1124395389 |
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Provider Enumeration Date | 11/16/2011 |
Last Update Date | 11/16/2011 |
Identifier | Type | State | Issuer |
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1124395389 | NPI | - | NPPES |
1856380 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 5638 (Louisiana) | Primary |