Provider Demographics
NPI:1083795462
Name:GORDON, NEWTON CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEWTON
Middle Name:CHARLES
Last Name:GORDON
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:SAN FRANCISCO GENERAL HOSPITAL, ROOM #1N15
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-5717
Mailing Address - Fax:415-206-5834
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:SAN FRANCISCO GENERAL HOSPITAL, SUITE #1N
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-6539
Practice Address - Fax:415-502-0817
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA264091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T08749Medicare UPIN