Provider Demographics
NPI:1902491517
Name:JAMES W GORDON DDS INC
Entity Type:Organization
Organization Name:JAMES W GORDON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-845-9130
Mailing Address - Street 1:8960 FITNESS LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8208
Mailing Address - Country:US
Mailing Address - Phone:317-845-9130
Mailing Address - Fax:317-845-9161
Practice Address - Street 1:8960 FITNESS LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8208
Practice Address - Country:US
Practice Address - Phone:317-845-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies