MEDICARE: DR. CHANDA MONEE' GORDON DDS

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	122300000X	Dentist	011655	GA

General Provider Information

NPI Number	:	1891899050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDA MONEE' GORDON DDS

Provider Business Mailing Address
First Line	:	7644 COLE LANE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349
Country	:	US
Telephone Number	:	404-550-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	5626 FULTON INDUSTRIAL BLVD.
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30336
Country	:	US
Telephone Number	:	404-550-4905
Fax Number	:

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	04/14/2009

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