MEDICARE: MICHAEL STEVEN GORDAY D.D.S., M.H.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
1	1223P0300X	Periodontics	12835	TX

General Provider Information

NPI Number	:	1235261991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL STEVEN GORDAY D.D.S., M.H.S.

Provider Business Mailing Address
First Line	:	1207 HIGH ROCK ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3428
Country	:	US
Telephone Number	:	210-495-0427
Fax Number	:	210-495-3068

Provider Business Practice Location Address
First Line	:	1100 NW LOOP 410
Second Line	:	505
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2263
Country	:	US
Telephone Number	:	210-341-6023
Fax Number	:	210-341-7332

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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