Provider Demographics
NPI:1073721163
Name:GORDON, MARCIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 HONEYGO BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4931
Mailing Address - Country:US
Mailing Address - Phone:410-933-1099
Mailing Address - Fax:410-933-6616
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-933-1099
Practice Address - Fax:410-933-6616
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD96191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52-2287990OtherTID