Provider Demographics
NPI:1720322852
Name:GORDON, JONATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 BRISTOL CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0696
Mailing Address - Country:US
Mailing Address - Phone:678-200-0569
Mailing Address - Fax:
Practice Address - Street 1:1401 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4802
Practice Address - Country:US
Practice Address - Phone:432-332-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23865122300000X
SC13654183500000X
GA024929183500000X
TX395331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist