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NPI Code Detail

MEDICARE: DR. STUART MARSHALL GORDON D.D.S.

MEDICARE: DR. STUART MARSHALL GORDON D.D.S.
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
11223P0700XProsthodontics7301MD

General Provider Information

NPI Number : 1205980935
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STUART MARSHALL GORDON D.D.S.
Provider Business Mailing Address
First Line : 16 GREENMEADOW DR
Second Line :
City : TIMONIUM
State : MD
Zip : 21093-3200
Country : US
Telephone Number : 410-308-9955
Fax Number : 410-308-9980
Provider Business Practice Location Address
First Line : 16 GREENMEADOW DR
Second Line :
City : TIMONIUM
State : MD
Zip : 21093-3200
Country : US
Telephone Number : 410-308-9955
Fax Number : 410-308-9980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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