Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3195 | SC |
NPI | 1013119445 |
---|---|
Provider Name | Dr. Roberta Zeigler Gardner |
First Address | Mt Pleasant, SC 29464-3154 |
Second Address | Mt Pleasant, SC 29464-3154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |