Provider Demographics
NPI:1134205586
Name:GORDON, JOHN A JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:GORDON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-8004
Mailing Address - Country:US
Mailing Address - Phone:630-878-0351
Mailing Address - Fax:630-357-7974
Practice Address - Street 1:901 WEST ROUTE 34
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545
Practice Address - Country:US
Practice Address - Phone:630-552-9200
Practice Address - Fax:630-552-9491
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist