Provider Demographics
NPI:1043641699
Name:GARDNER DENTISTS, LLC
Entity type:Organization
Organization Name:GARDNER DENTISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-710-4327
Mailing Address - Street 1:115 N MOONLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-2505
Mailing Address - Country:US
Mailing Address - Phone:913-856-7123
Mailing Address - Fax:913-856-7121
Practice Address - Street 1:115 N MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-2505
Practice Address - Country:US
Practice Address - Phone:913-856-7123
Practice Address - Fax:913-856-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty