Healthcare Provider Details

I. General information

NPI: 1790064376
Provider Name (Legal Business Name): GARY ALAN NORD JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MESEROLE ST APT #2B
BROOKLYN NY
11206-2189
US

IV. Provider business mailing address

127 MESEROLE ST APT #2B
BROOKLYN NY
11206-2189
US

V. Phone/Fax

Practice location:
  • Phone: 562-644-4059
  • Fax:
Mailing address:
  • Phone: 562-644-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number055668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: