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NPI Code Detail

MEDICARE: CHANEY B GORDY D.M.D.

MEDICARE: CHANEY B GORDY D.M.D.
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
1122300000XDentist8095FL

General Provider Information

NPI Number : 1902912298
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANEY B GORDY D.M.D.
Provider Business Mailing Address
First Line : 1216 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-6314
Country : US
Telephone Number : 407-422-1130
Fax Number : 407-841-5657
Provider Business Practice Location Address
First Line : 1216 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-6314
Country : US
Telephone Number : 407-422-1130
Fax Number : 407-841-5657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 04/18/2016

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