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General NPI Number Information
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NPI Number | 1487757308
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Entity Type | Individual
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Provider Name | DAVID MICHAEL GORDON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23 ROTARY WAY
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City | VALLEJO
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State | CA
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Zip | 94591-8475
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Country | US
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Telephone | 707-557-2200
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Fax | 707-642-7502
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Provider Business Mailing Address
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Address Line | 823 BANTRY COURT
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City | BENICIA
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State | CA
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Zip | 94510
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Country | US
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Telephone | 707-745-1344
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Fax | 707-642-7502
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 31465
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License Number State | CA
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