Provider Demographics
NPI:1386904456
Name:GARDNER, ORIETTA F (DDS)
Entity type:Individual
Prefix:
First Name:ORIETTA
Middle Name:F
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-2637
Mailing Address - Country:US
Mailing Address - Phone:281-427-5170
Mailing Address - Fax:281-422-1551
Practice Address - Street 1:515 PARK ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2637
Practice Address - Country:US
Practice Address - Phone:281-427-5170
Practice Address - Fax:281-422-1551
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist