Provider Demographics
NPI:1255962130
Name:GORDON & GORDON, DMD, PA
Entity type:Organization
Organization Name:GORDON & GORDON, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-434-3333
Mailing Address - Street 1:450 NEW MARKET BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5501
Mailing Address - Country:US
Mailing Address - Phone:828-386-1388
Mailing Address - Fax:828-386-1446
Practice Address - Street 1:450 NEW MARKET BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5501
Practice Address - Country:US
Practice Address - Phone:828-386-1388
Practice Address - Fax:828-386-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty