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Brock Gardner

Dental Public Health

107 S Prospect Rd
Bloomington , Illinois 61704-4403

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Brock Gardner

Dental Public Health

107 S Prospect Rd
Bloomington , Illinois 61704-4403

Write a Review Save Call

Brock Gardner

Dental Public Health

107 S Prospect Rd
Bloomington , Illinois 61704-4403

Write a Review Save

About


Features

Language(s) Spoken
English
Ethnic Identity
White / Caucasian

Specialties

  • Dental Public Health

Languages spoken

  • English

Location

107 S Prospect Rd Bloomington , Illinois 61704-4403

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


Where did Brock Gardner attend graduate school?

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Where did Brock Gardner do his residency?

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Where did Brock Gardner do his fellowship?

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Is Brock Gardner board certified?

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What type of doctor is Brock Gardner

Dental Public Health

In what state does Brock Gardner practice in?

Illinois

Where is Brock Gardner ’s practice located?

107 S Prospect Rd , Bloomington, Illinois, 61704-4403

What is Brock Gardner ’s gender?

Male

Is Brock Gardner a sole practitioner?

No

Is Brock Gardner accepting new patients?

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What languages does Brock Gardner speak?

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Does Brock Gardner accept insurance?

Yes, Brock Gardner accepts insurance

Does Brock Gardner offers telemedicine?

Brock Gardner has not indicated if he offers telemedicine

What is Brock Gardner ’s professional license number?

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What is Brock Gardner ’s NPI number?

1033602883

Does Brock Gardner have any license restrictions?

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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)

The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address

The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address

The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code

The code describing the type of health care provider that is being assigned an NPI. The entity type codes are:
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?

Subparts are the components and separate physical locations of organization health care providers. Subpart examples include: Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name

The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.

Provider Enumeration Date

The date the provider was assigned a unique identifier (assigned an NPI)

Last Update Date

The date that a NPI record was last updated or changed

Primary Taxonomy Code

The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPls the license data is associated to the taxonomy code.

Authorized Official Name

The name of the person authorized to submit the PI application or to officially change data for a health care provider.

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