Provider Demographics
NPI:1548281942
Name:GORDON, MARC E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:GORDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:E
Other - Last Name:GORDON PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-0335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3508 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3345
Practice Address - Country:US
Practice Address - Phone:732-364-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ157681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics