Provider Demographics
NPI:1427268036
Name:DON GORDY DDS PA
Entity type:Organization
Organization Name:DON GORDY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:C
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-843-3183
Mailing Address - Street 1:721 WAKARUSA DRIVE
Mailing Address - Street 2:STE 102
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4797
Mailing Address - Country:US
Mailing Address - Phone:785-843-3183
Mailing Address - Fax:785-843-3184
Practice Address - Street 1:721 WAKARUSA DRIVE
Practice Address - Street 2:STE 102
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4797
Practice Address - Country:US
Practice Address - Phone:785-843-3183
Practice Address - Fax:785-843-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty