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Contact Information

BROCK GARDNER
107 S PROSPECT RD
BLOOMINGTON, IL61704-4403
 Phone: 309-808-6263
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for BROCK GARDNER · (Male)

NPI Number 1033602883
Status Active
Credentials
Entity Individual
Enumeration date 06/06/2018
Last updated 06/06/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 019.031653
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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