Doctor Name: | THAYNE HENRIE GARDNER |
NPI Number: | 1073804001 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | D-4480-PD |
Business Practice Address: | 1268 W South Jordan Pkwy Suite 101 South Jordan, UT - 840954652 |
Business Phone Number: | 8014468007 |
Business Fax Number: | 8016761030 |
Mailing Address: | 1268 W South Jordan Pkwy, Suite 101 SOUTH JORDAN |
State: | UT |
Postal Code: | 840954652 |
Phone Number: | 8014468007 |
Fax Number: | 8016761030 |
NPI Enumeration Date: | 04/25/2011 |
NPI Last Update Date: | 02/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | D-4480-PD |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |