IndividualActive
Brock Gardner
NPI 1033602883 · Public Health Dentistry · Bloomington, IL
Provider details
- NPI number
- 1033602883
- Entity type
- Individual
- Primary specialty
- Public Health DentistryDental Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 019.031653 (IL)
Specialties & taxonomies
Dental Providers
Practice location
107 S Prospect Rd
Bloomington, IL 61704-4403
Phone: (309) 808-6263
Approximate (ZIP-level) locationGet directions
Mailing address
306 Larkspur Turn
Peachtree City, GA 30269-2210
Registry dates
- Enumerated
- 2018-06-06
- Last updated
- 2018-06-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.