Provider Demographics
NPI:1073784922
Name:GORDON J. ROZNIK DMD PA
Entity Type:Organization
Organization Name:GORDON J. ROZNIK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PA
Authorized Official - Phone:704-375-7711
Mailing Address - Street 1:400 S TRYON
Mailing Address - Street 2:SUITE M4
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28285-1901
Mailing Address - Country:US
Mailing Address - Phone:704-375-7711
Mailing Address - Fax:704-375-3470
Practice Address - Street 1:400 S TRYON
Practice Address - Street 2:SUITE M4
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28285-1901
Practice Address - Country:US
Practice Address - Phone:704-375-7711
Practice Address - Fax:704-375-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty