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NPI Code Detail

MEDICARE: JONATHAN GORDON LOW DDS

MEDICARE: JONATHAN GORDON LOW 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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry105298CA

General Provider Information

NPI Number : 1124687314
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN GORDON LOW DDS
Provider Business Mailing Address
First Line : 3031 W MARCH LN STE 340
Second Line :
City : STOCKTON
State : CA
Zip : 95219-6562
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3031 W MARCH LN STE 340
Second Line :
City : STOCKTON
State : CA
Zip : 95219-6562
Country : US
Telephone Number : 209-981-8889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 08/20/2020

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Directions to “ JONATHAN GORDON LOW DDS” Practice Location

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