MEDICARE: DR. ALEXANDRA 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
1	122300000X	Dentist	DN15162	FL

General Provider Information

NPI Number	:	1760692537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA GORDON D.D.S.

Provider Business Mailing Address
First Line	:	11645 BISCAYNE BLVD STE 204
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3138
Country	:	US
Telephone Number	:	786-213-5706
Fax Number	:	786-206-7040

Provider Business Practice Location Address
First Line	:	11645 BISCAYNE BLVD STE 204
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3138
Country	:	US
Telephone Number	:	305-892-2960
Fax Number	:	305-892-2927

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/03/2008

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