Provider Demographics
NPI:1386727014
Name:TOWNSEND, GORDON L (DDS, PA)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:L
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4231
Mailing Address - Country:US
Mailing Address - Phone:910-892-7370
Mailing Address - Fax:910-892-1331
Practice Address - Street 1:212 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4231
Practice Address - Country:US
Practice Address - Phone:910-892-7370
Practice Address - Fax:910-892-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC822090OtherUNITED CONCORDIA
NC98514OtherBCBS ID #
NC8998514Medicaid