Healthcare Provider Details

I. General information

NPI: 1548637192
Provider Name (Legal Business Name): TAYLOR R. GORDON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST
PITTSBURGH PA
15213-2523
US

IV. Provider business mailing address

3501 TERRACE ST
PITTSBURGH PA
15213-2523
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-8616
  • Fax:
Mailing address:
  • Phone: 412-648-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDS040604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: