Healthcare Provider Details

I. General information

NPI: 1538269709
Provider Name (Legal Business Name): STEVE A GORMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11090 SERENBE LN STE 300
CHATTAHOOCHEE HILLS GA
30268-2474
US

IV. Provider business mailing address

1198 MADO LOOP
CHATTAHOOCHEE HILLS GA
30268-2494
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-6422
  • Fax:
Mailing address:
  • Phone: 612-209-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: