Provider Demographics
NPI:1063628881
Name:GORDON, HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
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 1:21308 73RD AVE
Mailing Address - Street 2:1N
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2860
Mailing Address - Country:US
Mailing Address - Phone:718-465-4583
Mailing Address - Fax:718-465-2551
Practice Address - Street 1:21308 73RD AVE
Practice Address - Street 2:1N
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2860
Practice Address - Country:US
Practice Address - Phone:718-465-4583
Practice Address - Fax:718-465-2551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0269551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice