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General NPI Number Information
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NPI Number | 1679791453
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Entity Type | Individual
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Provider Name | CECILLE GORDON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 128 STEVENS AVE
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City | MT VERNON
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State | NY
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Zip | 10550-2604
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Country | US
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Telephone | 914-668-2772
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Fax | 914-668-2657
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Provider Business Mailing Address
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Address Line | 80 LAWN AVE UNIT #12
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City | STAMFORD
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State | CT
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Zip | 06902-3123
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 045979
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009501
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License Number State | CT
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