Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29716 | CA |
NPI | 1073946281 |
---|---|
Provider Name | Dr. Daniel George Gardiner |
First Address | Upland, CA 91786-4583 |
Second Address | Upland, CA 91786-4583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 12/08/2013 |