Provider Demographics
NPI:1386774503
Name:GORDON, FRANKLIN L (DDS, MS,MS,PC)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:L
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS, MS,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1700
Mailing Address - Country:US
Mailing Address - Phone:734-994-0864
Mailing Address - Fax:
Practice Address - Street 1:1295 S LINDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3498
Practice Address - Country:US
Practice Address - Phone:810-230-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID1346201223E0200X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA2200055OtherEMDEON BUSINESS SERVICES