Brock Gardner
Dental Public Health
107 S Prospect Rd
Bloomington
, Illinois 61704-4403
Brock Gardner
Dental Public Health
107 S Prospect Rd
Bloomington
, Illinois 61704-4403
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About
Features
Specialties
- Dental Public Health
Languages spoken
- English
Location
First Address
- Brock Gardner
- 306 Larkspur Turn
- Peachtree City, GA
- Zip : 30269-2210
- Phone :
Second Address
- Brock Gardner
- 107 S Prospect Rd
- Bloomington, IL
- Zip : 61704-4403
- Phone : (309) 808-6263
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223D0001X | Dental Public Health | 019.031653 | IL |
National Provider Identifier
| NPI | 1033602883 |
|---|---|
| Provider Name | Brock Gardner |
| First Address | Peachtree City, GA 30269-2210 |
| Second Address | Bloomington, IL 61704-4403 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/06/2018 |
| Last Update Date | 06/06/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.