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NPI Code Detail

MEDICARE: DR. ROBERT SCOTT GORDON DMD

MEDICARE: DR. ROBERT SCOTT GORDON DMD
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
1122300000XDentist9441CO

General Provider Information

NPI Number : 1518122118
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT SCOTT GORDON DMD
Provider Business Mailing Address
First Line : 2902 EVERGREEN PKWY
Second Line :
City : EVERGREEN
State : CO
Zip : 80439-7916
Country : US
Telephone Number : 303-674-5566
Fax Number :
Provider Business Practice Location Address
First Line : 2902 EVERGREEN PARKWAY
Second Line :
City : EVERGREEN
State : CO
Zip : 80439-7998
Country : US
Telephone Number : 303-674-5566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2008
Last Update Date : 06/27/2023

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