Provider Demographics
NPI:1427077866
Name:GORDON, STANLEY KIRK (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:KIRK
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 NW 44TH CT
Mailing Address - Street 2:COAST GUARD AIR STATION MIAMI
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2304
Mailing Address - Country:US
Mailing Address - Phone:305-953-2359
Mailing Address - Fax:305-953-2251
Practice Address - Street 1:14750 NW 44TH CT
Practice Address - Street 2:COAST GUARD AIR STATION MIAMI
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2304
Practice Address - Country:US
Practice Address - Phone:305-953-2359
Practice Address - Fax:305-953-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist