Healthcare Provider Details

I. General information

NPI: 1427435791
Provider Name (Legal Business Name): DR. MICHAEL J. GORDON, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 N OXFORD ST
CLAREMONT NC
28610-9661
US

IV. Provider business mailing address

2953 N OXFORD ST
CLAREMONT NC
28610-9661
US

V. Phone/Fax

Practice location:
  • Phone: 828-459-1400
  • Fax: 828-459-0200
Mailing address:
  • Phone: 828-459-1400
  • Fax: 828-459-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9539
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9539
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL JAY GORDON JR.
Title or Position: PRESIDENT
Credential:
Phone: 828-459-1400