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General NPI Number Information
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NPI Number | 1962240903
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Entity Type | Individual
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Provider Name | KARA COOK GORDON DMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 808 WAPPOO RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5865
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Country | US
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Telephone | 843-212-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ALEXANDER ST APT A
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City | CHARLESTON
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State | SC
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Zip | 29401-3565
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Country | US
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Telephone | 601-988-5930
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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 | DGD.10836
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License Number State | SC
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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 | DGD.10836
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License Number State | SC
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