MEDICARE: DR. ALAN 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
1	1223G0001X	General Practice Dentistry	7777	MD

General Provider Information

NPI Number	:	1619121555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN GORDON D,D.S.

Provider Business Mailing Address
First Line	:	4400 STAMP RD
Second Line	:	SUITE #313
City	:	MARLOW HEIGHTS
State	:	MD
Zip	:	20748-6716
Country	:	US
Telephone Number	:	301-423-0264
Fax Number	:	301-423-2572

Provider Business Practice Location Address
First Line	:	4400 STAMP RD
Second Line	:	SUITE #313
City	:	MARLOW HEIGHTS
State	:	MD
Zip	:	20748-6716
Country	:	US
Telephone Number	:	301-423-0264
Fax Number	:	301-423-2572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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