MEDICARE: DR. STEPHEN JEROME GORDON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019016354	IL

General Provider Information

NPI Number	:	1114954146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JEROME GORDON DDS

Provider Business Mailing Address
First Line	:	8 SOUTH MICHIGAN AVENUE
Second Line	:	SUITE 1800
City	:	CHICAGO
State	:	IL
Zip	:	60603-3357
Country	:	US
Telephone Number	:	312-750-9000
Fax Number	:	312-750-9100

Provider Business Practice Location Address
First Line	:	8 SOUTH MICHIGAN AVENUE
Second Line	:	SUITE 1800
City	:	CHICAGO
State	:	IL
Zip	:	60603-3357
Country	:	US
Telephone Number	:	312-750-9000
Fax Number	:	312-750-9100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/04/2010

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