Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
BROCK GARDNER
ActiveBROCK GARDNER is a Dental Public Health healthcare provider located in BLOOMINGTON, Illinois. NPI 1033602883 is currently active in the NPPES registry. Verify at CMS.
Dental Public Health · BLOOMINGTON, IL
Registration Details
- NPI Number
- 1033602883
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 6, 2018 (8.2257868280805 yrs)
- Last Updated
- Jun 6, 2018
- License
-
019.031653 (IL)
Practice Information
- Address
-
107 S PROSPECT RDBLOOMINGTON, IL, 617044403Browse IL providers · Browse ZIP 61704
- Phone
- 3098086263
- Primary Specialty
-
Dental Public Health
1223D0001X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.