Provider Demographics
NPI:1699728899
Name:GARDNER, STEPHEN DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DANIEL
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-5076
Mailing Address - Country:US
Mailing Address - Phone:843-795-5565
Mailing Address - Fax:843-795-2329
Practice Address - Street 1:849 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-5076
Practice Address - Country:US
Practice Address - Phone:843-795-5565
Practice Address - Fax:843-795-2329
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice