MEDICARE: DR. GORDON A ZAYON 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
1	122300000X	Dentist	DS021561L	PA

General Provider Information

NPI Number	:	1467568543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON A ZAYON DDS

Provider Business Mailing Address
First Line	:	500 S BROAD ST
Second Line	:	DENTAL SUITE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1613
Country	:	US
Telephone Number	:	215-685-6768
Fax Number	:	215-685-6891

Provider Business Practice Location Address
First Line	:	2230 COTTMAN AVE
Second Line	:	HEALTH CENTER #10
City	:	PHILA
State	:	PA
Zip	:	19149-1230
Country	:	US
Telephone Number	:	215-685-0602
Fax Number	:	215-725-4877

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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