Provider Demographics
NPI:1730152182
Name:GORDON, WILLIAM MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:GORDON
Suffix:
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 1:840 TIOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-828-1171
Mailing Address - Fax:401-828-4704
Practice Address - Street 1:840 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-828-1171
Practice Address - Fax:401-828-4704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI24211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics