Provider Demographics
NPI:1841925302
Name:GARDNER, SEAN CAVENDISH (DDS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:CAVENDISH
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 1:4903 OWL HAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4736
Mailing Address - Country:US
Mailing Address - Phone:210-571-3919
Mailing Address - Fax:
Practice Address - Street 1:3740 COLONY DR STE 254
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2233
Practice Address - Country:US
Practice Address - Phone:210-690-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist