Healthcare Provider Details

I. General information

NPI: 1588365860
Provider Name (Legal Business Name): ROSS GORDON DDS MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 OFFICE PKWY STE B
WESTERVILLE OH
43082-7812
US

IV. Provider business mailing address

627 OFFICE PKWY STE B
WESTERVILLE OH
43082-7812
US

V. Phone/Fax

Practice location:
  • Phone: 714-905-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSS GORDON
Title or Position: OWNER
Credential: DDS
Phone: 614-905-0111