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General NPI Number Information
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NPI Number | 1396362638
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Entity Type | Organization
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Legal Business Name | PHILIP J GORDON DDS PA
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 3628 W 95TH ST
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City | LEAWOOD
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State | KS
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Zip | 66206-2035
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Country | US
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Telephone | 913-649-5017
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Fax | 913-661-7186
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Provider Business Mailing Address
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Address Line | 3628 W 95TH ST
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City | LEAWOOD
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State | KS
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Zip | 66206-2035
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Country | US
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Telephone | 913-649-5017
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Fax | 913-661-7186
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP GORDON
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Credential | DDS
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Telephone | 913-649-5017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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