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General NPI Number Information
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NPI Number | 1073992483
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Entity Type | Organization
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Legal Business Name | STEPHEN E. GORK, DDS,PC
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 26771 W 12 MILE RD G-115
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-353-7440
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Fax | 248-353-3148
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Provider Business Mailing Address
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Address Line | 26771 W 12 MILE RD G-115
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-353-7440
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Fax | 248-353-3148
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN EDWARD GORK
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Credential | DDS
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Telephone | 248-353-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12696
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License Number State | MI
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