Provider Demographics
NPI:1619121555
Name:GORDON, ALAN (D,DS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 STAMP RD
Mailing Address - Street 2:SUITE #313
Mailing Address - City:MARLOW HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6716
Mailing Address - Country:US
Mailing Address - Phone:301-423-0264
Mailing Address - Fax:301-423-2572
Practice Address - Street 1:4400 STAMP RD
Practice Address - Street 2:SUITE #313
Practice Address - City:MARLOW HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748-6716
Practice Address - Country:US
Practice Address - Phone:301-423-0264
Practice Address - Fax:301-423-2572
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD77771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice