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General NPI Number Information
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NPI Number | 1821989997
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Entity Type | Individual
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Provider Name | SAMICA GORDON DDS
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 5307 HILDENBRAND WAY
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City | LIBERTY TWP
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State | OH
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Zip | 45011-3078
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Country | US
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Telephone | 513-759-7635
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Fax |
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Provider Business Mailing Address
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Address Line | 3065 GRANNY SMITH LN
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City | MIDDLETOWN
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State | OH
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Zip | 45044-7955
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Country | US
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Telephone | 513-306-9280
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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 | 30.028124
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License Number State | OH
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