Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DD1867 | NM |
NPI | 1003905043 |
---|---|
Provider Name | Dr. William C Gardner |
First Address | Albuquerque, NM 87122-2942 |
Second Address | Albuquerque, NM 87122-2942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |