MEDICARE: DR. PAUL E GORDON DMD, M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8424	MA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	246483	MA

General Provider Information

NPI Number	:	1164448171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL E GORDON DMD, M.D.

Provider Business Mailing Address
First Line	:	77 S BEDFORD ST STE 100
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5154
Country	:	US
Telephone Number	:	781-272-0800
Fax Number	:	781-272-0806

Provider Business Practice Location Address
First Line	:	77 S BEDFORD ST STE 100
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5154
Country	:	US
Telephone Number	:	781-272-0800
Fax Number	:	781-272-0806

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/09/2019

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