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NPI Code Detail

MEDICARE: DR. WILLIAM EDWARD GORDON D.D.S

MEDICARE: DR. WILLIAM EDWARD GORDON D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019029816IL

General Provider Information

NPI Number : 1497169882
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM EDWARD GORDON D.D.S
Provider Business Mailing Address
First Line : 1841 W 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-3844
Country : US
Telephone Number : 773-927-5568
Fax Number : 773-927-1692
Provider Business Practice Location Address
First Line : 635 CHICAGO AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-2365
Country : US
Telephone Number : 847-491-0880
Fax Number : 773-927-1692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2014
Last Update Date : 06/16/2014

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