Provider Demographics
NPI:1043233828
Name:GORDON, HARVEY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:P
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 N 35TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5433
Mailing Address - Country:US
Mailing Address - Phone:954-963-3535
Mailing Address - Fax:
Practice Address - Street 1:1051 N 35TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5433
Practice Address - Country:US
Practice Address - Phone:954-963-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 63791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice