Healthcare Provider Details

I. General information

NPI: 1790254001
Provider Name (Legal Business Name): ALAN C. GORDON, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 AUTH PL STE 490
CAMP SPRINGS MD
20746-4212
US

IV. Provider business mailing address

4710 AUTH PL STE 490
CAMP SPRINGS MD
20746-4212
US

V. Phone/Fax

Practice location:
  • Phone: 301-848-6502
  • Fax:
Mailing address:
  • Phone: 301-848-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN GORDON
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 301-848-6502