Provider Demographics
NPI:1427435791
Name:DR. MICHAEL J. GORDON, DDS, PA
Entity type:Organization
Organization Name:DR. MICHAEL J. GORDON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-459-1400
Mailing Address - Street 1:2953 N OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28610-9661
Mailing Address - Country:US
Mailing Address - Phone:828-459-1400
Mailing Address - Fax:828-459-0200
Practice Address - Street 1:2953 N OXFORD ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NC
Practice Address - Zip Code:28610-9661
Practice Address - Country:US
Practice Address - Phone:828-459-1400
Practice Address - Fax:828-459-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9539122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty