Healthcare Provider Details

I. General information

NPI: 1255872180
Provider Name (Legal Business Name): AMBER IVEY GORDON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SILVERWOOD COMMERCIAL DR STE 400
RINCON GA
31326-5199
US

IV. Provider business mailing address

131 SILVERWOOD COMMERCIAL DR STE 400
RINCON GA
31326-5199
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-1905
  • Fax:
Mailing address:
  • Phone: 912-826-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015426
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: