Provider Demographics
NPI:1538269709
Name:GORMAN, STEVE A (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:A
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 MADO LOOP
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE HILLS
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2494
Mailing Address - Country:US
Mailing Address - Phone:612-209-7315
Mailing Address - Fax:
Practice Address - Street 1:11090 SERENBE LN STE 300
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE HILLS
Practice Address - State:GA
Practice Address - Zip Code:30268-2474
Practice Address - Country:US
Practice Address - Phone:770-771-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1229731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice