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General NPI Number Information
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NPI Number | 1235560574
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Entity Type | Organization
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Legal Business Name | JOE R. GORHAM DDS,INC.
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 2222 N PRAIRIE CREEK RD
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City | DALLAS
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State | TX
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Zip | 75227-8101
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Country | US
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Telephone | 214-388-7416
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 N PRAIRIE CREEK RD
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City | DALLAS
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State | TX
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Zip | 75227-8101
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Country | US
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Telephone | 214-388-7416
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MRS. JEAN M BADER
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Credential |
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Telephone | 214-388-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7599
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License Number State | TX
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