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General NPI Number Information
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NPI Number | 1114045879
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Entity Type | Individual
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Provider Name | GORDON L SANGREE DDS
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 498 N MAIN ST
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City | BARNEGAT
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State | NJ
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Zip | 08005-2422
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Country | US
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Telephone | 609-698-7770
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Fax | 609-660-0663
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Provider Business Mailing Address
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Address Line | 174 WELLS MILL RD
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City | WARETOWN
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State | NJ
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Zip | 08758-2607
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Country | US
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Telephone | 609-971-3187
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Fax | 609-660-0663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12976
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License Number State | NJ
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