=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790254001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN C. GORDON, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2018
-----------------------------------------------------
Last Update Date | 11/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4710 AUTH PL STE 490
-----------------------------------------------------
City | CAMP SPRINGS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20746-4212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-848-6502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4710 AUTH PL STE 490
-----------------------------------------------------
City | CAMP SPRINGS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20746-4212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-848-6502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. ALAN GORDON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 301-848-6502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------