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NPI Code Detail

MEDICARE: KAREN L GORDON RDH

MEDICARE: KAREN L GORDON RDH
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
1124Q00000XDental HygienistDH19214FL

General Provider Information

NPI Number : 1255536777
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN L GORDON RDH
Provider Business Mailing Address
First Line : 10569 LAKE BREEZE DR
Second Line :
City : SEMINOLE
State : FL
Zip : 33772-4333
Country : US
Telephone Number : 727-393-7269
Fax Number :
Provider Business Practice Location Address
First Line : 600 8TH AVE SE
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33701-5030
Country : US
Telephone Number : 727-502-1586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 07/08/2007

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