Provider Demographics
NPI:1386955508
Name:GARDNER, DAVIS WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:WAYNE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E WINDSOR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VA
Mailing Address - Zip Code:23487-9443
Mailing Address - Country:US
Mailing Address - Phone:804-359-5733
Mailing Address - Fax:757-242-6789
Practice Address - Street 1:70 E WINDSOR BLVD STE D
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VA
Practice Address - Zip Code:23487-9443
Practice Address - Country:US
Practice Address - Phone:804-359-5733
Practice Address - Fax:757-242-6789
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014128471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice