Provider Demographics
NPI:1114045879
Name:SANGREE, GORDON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:L
Last Name:SANGREE
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 1:174 WELLS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-2607
Mailing Address - Country:US
Mailing Address - Phone:609-971-3187
Mailing Address - Fax:609-660-0663
Practice Address - Street 1:498 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2422
Practice Address - Country:US
Practice Address - Phone:609-698-7770
Practice Address - Fax:609-660-0663
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ129761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice