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General NPI Number Information
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NPI Number | 1578053922
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Entity Type | Individual
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Provider Name | TAMARA GORDON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 3013 E MARKET ST STE 100
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City | YORK
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State | PA
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Zip | 17402-2513
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Country | US
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Telephone | 914-712-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 3013 E MARKET ST STE 100
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City | YORK
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State | PA
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Zip | 17402-2513
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Country | US
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Telephone |
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Fax |
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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 | 060845
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042514
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License Number State | PA
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