Healthcare Provider Details

I. General information

NPI: 1932280567
Provider Name (Legal Business Name): FRANCES MORAN GORDY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

217 EDINBURGH CT
BRANDON MS
39047-8039
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6185
  • Fax: 601-984-6187
Mailing address:
  • Phone: 601-992-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1832-79
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: